Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 00845 | Date 30/08/2018 |
| Token No | SM/18-19/1079 30/08/2018 | Serial | 033 Last Visit: 30/08/2018 |
| Patient Name | Mr. SAMAESH DAS | Contact No | 9830309916 |
| Address | 18, RAJA K.L GOSWAMI STREET | Age | 10.0 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 45 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||