Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 05749 | Date 13/07/2019 |
| Token No | SM/19-20/6352 13/07/2019 | Serial | 016 Last Visit: 13/07/2019 |
| Patient Name | Mrs. MOMENA KHATUN | Contact No | 9875568683 |
| Address | BAHIR SERAMPORE, | Age | 18 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 41 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||