Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05078 | Date 11/05/2019 |
| Token No | SM/19-20/2588 11/05/2019 | Serial | 076 Last Visit: 11/05/2019 |
| Patient Name | Mr. SK SHAHREKH | Contact No | 9038164940 |
| Address | 29A CHATRA MUSALMAN PARA /LANE | Age | 14 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 30 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||