Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04403 | Date 26/03/2019 |
| Token No | SM/18-19/11264 26/03/2019 | Serial | 057 Last Visit: 26/03/2019 |
| Patient Name | Mr. MANOJIT ADHIKARY | Contact No | 6291229117 |
| Address | 21 KUMIR JELA ROAD SERAMPORE | Age | 20 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||