Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 10090 | Date 16/09/2021 |
| Token No | SM/21-22/5143 16/09/2021 | Serial | 015 Last Visit: 26/10/2021 |
| Patient Name | Miss LAXMI SAHA | Contact No | 9874178224 |
| Address | 55,BARABAGAN LANE SERAMPORE | Age | 14 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||