Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05047 | Date 08/05/2019 |
| Token No | SM/19-20/2391 08/05/2019 | Serial | 082 Last Visit: 08/05/2019 |
| Patient Name | Mr. SK DILSAR | Contact No | |
| Address | 5/A MUSALMAN PARA BYE LANE CHATRA SERAMPORE | Age | 12 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 25 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||