Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 06921 | Date 19/11/2019 |
| Token No | SM/19-20/13581 19/11/2019 | Serial | 078 Last Visit: 19/11/2019 |
| Patient Name | Miss RUHINA KHATUN | Contact No | |
| Address | CHATRA MUSALMAN PARA BYE LANE SERAMPORE | Age | 7 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 25 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||