Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 08120 | Date 20/04/2020 |
| Token No | SM/19-20/21378 20/04/2020 | Serial | 053 Last Visit: 20/04/2020 |
| Patient Name | Miss KEYA DAS | Contact No | 7449570446 |
| Address | 8 NO MUSALMAN PARA ROAD | Age | 16 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||