Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04279 | Date 18/03/2019 |
| Token No | SM/18-19/10756 18/03/2019 | Serial | 055 Last Visit: 18/03/2019 |
| Patient Name | Mr. PARIMAL MODAK | Contact No | 9123616993 |
| Address | 13 SANPUKUR DAHR RAMKRISHNA NAGAR, BAIDYABATI(M) | Age | 55 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 41 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||