Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05563 | Date 25/06/2019 |
| Token No | SM/19-20/16076 31/12/2019 | Serial | 018 Last Visit: 31/12/2019 |
| Patient Name | Miss MOUSUMI SIL | Contact No | 7596941157 |
| Address | 100/85 VIVEKANAND SARANI , NABAGRAM , BAIDYABATI(M) | Age | 11 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||