Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 05067 | Date 10/05/2019 |
| Token No | SM/19-20/2509 10/05/2019 | Serial | 106 Last Visit: 21/05/2019 |
| Patient Name | Miss SUBITA DAS | Contact No | 8479937447 |
| Address | 192 RAJDHARPUR GOV. COLONY SERAMPORE | Age | 15 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 46 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||