Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 06542 | Date 25/09/2019 |
| Token No | SM/19-20/11112 25/09/2019 | Serial | 054 Last Visit: 25/09/2019 |
| Patient Name | Miss OMKERSWARI ROY | Contact No | 9903170770 |
| Address | 280/9/A BAIDYABATI (M)RAMKRISNA ROAD, | Age | 6 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 16 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||