Ticket for Outdoor Patient
| Ward No. 21 | U-PHC No. | Registration No. 05501 | Date 21/06/2019 |
| Token No | SM/19-20/4986 21/06/2019 | Serial | 012 Last Visit: 21/06/2019 |
| Patient Name | Mr. ANKAN SAHA | Contact No | 9088144336 |
| Address | SHEORAPHULI SHIBAJI BAG | Age | 10 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||