Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03933 | Date 01/03/2019 |
| Token No | SM/18-19/9662 01/03/2019 | Serial | 037 Last Visit: 01/03/2019 |
| Patient Name | Miss INSURA BEGAM | Contact No | 9830801904 |
| Address | 9 CHATRA ARBINDA SARANI SERAMPORE | Age | 12 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 24.5 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||