Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 09170 | Date 14/01/2021 |
| Token No | SM/20-21/29346 14/01/2021 | Serial | 012 Last Visit: 14/01/2021 |
| Patient Name | Mr. SIBAM KUMAR SHAW | Contact No | 7890229935 |
| Address | 33 BOROBAGAN LANE, | Age | 8 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||