Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05498 | Date 20/06/2019 |
| Token No | SM/19-20/4949 20/06/2019 | Serial | 089 Last Visit: 20/06/2019 |
| Patient Name | Miss NISHA DAS | Contact No | 9903253906 |
| Address | 20 PNK BANERJEE LANE CHATRA SERAMPORE | Age | 10 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 29 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||