Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 05817 | Date 17/07/2019 |
| Token No | SM/19-20/6725 17/07/2019 | Serial | 097 Last Visit: 17/07/2019 |
| Patient Name | Miss SHAMPA DAS | Contact No | 7998506845 |
| Address | CHATRA BAGER BAGAN TELIPARA | Age | 16 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||