Ticket for Outdoor Patient
| Ward No. 16 | U-PHC No. | Registration No. 04440 | Date 28/03/2019 |
| Token No | SM/18-19/11433 28/03/2019 | Serial | 035 Last Visit: 28/03/2019 |
| Patient Name | Mr. GOPAL NAYAK | Contact No | 7044373690 |
| Address | J.N LAHIRI ROAD HARIJAN JUBLEE MODEL BASTI SERAMPORE | Age | 39 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 70 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||