Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04321 | Date 20/03/2019 |
| Token No | SM/18-19/11050 23/03/2019 | Serial | 054 Last Visit: 23/03/2019 |
| Patient Name | Mr. GOPAL DAS | Contact No | 9883831748 |
| Address | 162D/F CHATRA TELI PARA BAGER BAGAN, BAIDYABATI(M) | Age | 50 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 69 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||