Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 05613 | Date 28/06/2019 |
| Token No | SM/19-20/5540 28/06/2019 | Serial | 044 Last Visit: 28/06/2019 |
| Patient Name | Mr. SAHID ALI | Contact No | 8100655097 |
| Address | 16/C RABINDRA BHABAN, | Age | 12 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 49 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||