Ticket for Outdoor Patient
| Ward No. 20 | U-PHC No. | Registration No. 10114 | Date 23/09/2021 |
| Token No | SM/21-22/5359 23/09/2021 | Serial | 004 Last Visit: 28/09/2021 |
| Patient Name | Miss ALIVIA CHOWDHURY | Contact No | 8017494527 |
| Address | PIYARAPUR ROAD,CHARA BAGAN,BAIDYABATI(M) | Age | 17 YRS Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||