Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04301 | Date 19/03/2019 |
| Token No | SM/18-19/10866 19/03/2019 | Serial | 059 Last Visit: 19/03/2019 |
| Patient Name | Mr. ASIM MONDAL | Contact No | 7044723776 |
| Address | 127 TELI PARA CHATRA BAGER BAGAN, BAIDYABATI (M) | Age | 34 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 54 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||