Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03119 | Date 21/01/2019 |
| Token No | SM/20-21/29852 28/01/2021 | Serial | 031 Last Visit: 01/04/2021 |
| Patient Name | Master SK SAYEM | Contact No | 9674112007 |
| Address | 21 CHATRA KUMAR PARA SERAMPORE | Age | 4 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||