Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04839 | Date 22/04/2019 |
| Token No | SM/19-20/1412 22/04/2019 | Serial | 127 Last Visit: 22/04/2019 |
| Patient Name | Mr. SUMANTA BERA | Contact No | |
| Address | SIYAKHALA | Age | 10 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 35 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||