Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 04901 | Date 25/04/2019 |
| Token No | SM/19-20/1621 25/04/2019 | Serial | 007 Last Visit: 25/04/2019 |
| Patient Name | Miss NISHA SHAW | Contact No | 7003147762 |
| Address | 281/B/1, GHOSAL PARA NABAGRAM, BAIDYABATI(M), MALLICKPARA | Age | 17 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 46 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||