Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05955 | Date 25/07/2019 |
| Token No | SM/19-20/7305 25/07/2019 | Serial | 058 Last Visit: 11/12/2019 |
| Patient Name | Miss AFSARA KHATUN | Contact No | 7044922144 |
| Address | 7A ARBINDA SARANI SERAMPORE | Age | 6 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 16 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||