Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 04734 | Date 17/04/2019 |
| Token No | SM/19-20/1027 17/04/2019 | Serial | 034 Last Visit: 11/11/2019 |
| Patient Name | Mr. MD MUSTAFA | Contact No | |
| Address | 12 MUSALMAN PARA BYE LANE SERAMPORE | Age | 6 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 15 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||