Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 04743 | Date 17/04/2019 |
| Token No | SM/19-20/1055 17/04/2019 | Serial | 062 Last Visit: 17/04/2019 |
| Patient Name | Miss TANI JASWARA | Contact No | 9433178665 |
| Address | 11 RABINDRA BHAWAN ROAD SERAMPORE HOOGHLY | Age | 8 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 17 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||