Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 06611 | Date 14/10/2019 |
| Token No | SM/19-20/11610 14/10/2019 | Serial | 004 Last Visit: 14/10/2019 |
| Patient Name | Miss SHAGUFA PARVEEN | Contact No | 8100653066 |
| Address | 28/2 GANDHI SARAK RISHRA | Age | 10 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 20 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||