Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 04355 | Date 25/03/2019 |
| Token No | SM/18-19/11084 25/03/2019 | Serial | 004 Last Visit: 25/03/2019 |
| Patient Name | Mr. DILIP PAL | Contact No | 8017627172 |
| Address | 29/39 CHATRA TETUL TALA | Age | 44 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||