Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 01491 | Date 04/10/2018 |
| Token No | SM/19-20/2511 10/05/2019 | Serial | 108 Last Visit: 10/05/2019 |
| Patient Name | Mrs. PIAYASA SOM | Contact No | 8420919579 |
| Address | 17/D CHATRA DUTTA PARA | Age | 10 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 46 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||