Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04241 | Date 15/03/2019 |
| Token No | SM/18-19/10607 15/03/2019 | Serial | 100 Last Visit: 15/03/2019 |
| Patient Name | Mr. DEBASISH BANERJEE | Contact No | |
| Address | 11 CHATRA BAJAR ROAD | Age | 60 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 48 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||