Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03936 | Date 01/03/2019 |
| Token No | SM/18-19/9674 01/03/2019 | Serial | 049 Last Visit: 01/03/2019 |
| Patient Name | Miss TAMANA KHATOON | Contact No | 9804401213 |
| Address | 21 CHATRA KANAHAI DEWAN TALA LANE SERAMPORE HOOGHLY | Age | 14 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||