Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 06785 | Date 05/11/2019 |
| Token No | SM/19-20/12631 05/11/2019 | Serial | 005 Last Visit: 05/11/2019 |
| Patient Name | Miss SHAMIMA KHATOON | Contact No | 7278073890 |
| Address | 31 GANDHI SARAK , RISHRA | Age | 19 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 47 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||