Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05298 | Date 30/05/2019 |
| Token No | SM/19-20/3735 30/05/2019 | Serial | 028 Last Visit: 10/11/2020 |
| Patient Name | Miss SONALI KHATUN | Contact No | 8597483576 |
| Address | 40 CHATRA MUSALMAN PARA SERAMPORE | Age | 13 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 30 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||