Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05010 | Date 03/05/2019 |
| Token No | SM/19-20/2126 03/05/2019 | Serial | 030 Last Visit: 03/05/2019 |
| Patient Name | Miss TAMANA KHATUN | Contact No | 8240852522 |
| Address | CHATRA KUMAR PARA SERAMPORE | Age | 8 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 20 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||