Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04829 | Date 22/04/2019 |
| Token No | SM/19-20/1396 22/04/2019 | Serial | 111 Last Visit: 22/04/2019 |
| Patient Name | Mr. MANTOSH MALAKAR | Contact No | |
| Address | HAWA KHANA SEARMPORE | Age | 11 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 30 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||