Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04436 | Date 28/03/2019 |
| Token No | SM/18-19/11411 28/03/2019 | Serial | 013 Last Visit: 16/04/2019 |
| Patient Name | Mr. ASHOK KUMAR BAG | Contact No | 9674275239 |
| Address | 162/A BAGER BAGAN TELI PARA CHATRA , BAIDYABATI(M) | Age | 56 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 60 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||