Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 03108 | Date 21/01/2019 |
| Token No | SM/19-20/5617 29/06/2019 | Serial | 050 Last Visit: 29/06/2019 |
| Patient Name | Miss RUPSA MONDAL | Contact No | 9836324527 |
| Address | 58 DUTTA PARA LANE | Age | 15 YRS Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 57 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||