Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05625 | Date 29/06/2019 |
| Token No | SM/19-20/5619 29/06/2019 | Serial | 052 Last Visit: 29/06/2019 |
| Patient Name | Miss NANDINI GIRI | Contact No | 8582889856 |
| Address | 62/D GHOSAL PARA NABAGRAM BAIDYABATI(M) MALLICKPARA | Age | 8 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 19 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||