Ticket for Outdoor Patient
| Ward No. 7 | U-PHC No. | Registration No. 05177 | Date 21/05/2019 |
| Token No | SM/19-20/3097 21/05/2019 | Serial | 045 Last Visit: 21/05/2019 |
| Patient Name | Miss RIMA KHATUN | Contact No | 9051756971 |
| Address | 63 N.N RAY STREET SERAMPORE | Age | 14 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 42 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||