Ticket for Outdoor Patient
| Ward No. 6 | U-PHC No. | Registration No. 05005 | Date 03/05/2019 |
| Token No | SM/19-20/2116 03/05/2019 | Serial | 020 Last Visit: 03/05/2019 |
| Patient Name | Miss PRIYANKA BHAKAT | Contact No | 9674327989 |
| Address | 20 CHALO PATTI LANE(COLD DIPO)SHEORAPHULY,BAIDYABATI(M) | Age | 13 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 36 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||