Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05086 | Date 13/05/2019 |
| Token No | SM/19-20/6612 16/07/2019 | Serial | 060 Last Visit: 16/07/2019 |
| Patient Name | Mr. SK SAMIR | Contact No | 7890277803 |
| Address | CHATRA KANAI DEWANTALA | Age | 6 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 25 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||