Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 06647 | Date 16/10/2019 |
| Token No | SM/19-20/11790 16/10/2019 | Serial | 008 Last Visit: 16/10/2019 |
| Patient Name | Miss KHUSBU NISA | Contact No | 8981310958 |
| Address | 10 CHATRA CHATUGANG , BAIDYBATI(M) | Age | 13 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 31 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||