Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 00777 | Date 28/08/2018 |
| Token No | SM/18-19/1078 30/08/2018 | Serial | 032 Last Visit: 15/09/2018 |
| Patient Name | Mr. MAHADEB DAS | Contact No | 7890210986 |
| Address | GODAR BAGAN/ LANE CHATRA , BAIDYABATI(M) | Age | 28.0 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||