Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 01217 | Date 19/09/2018 |
| Token No | SM/18-19/1815 19/09/2018 | Serial | 027 Last Visit: 19/09/2018 |
| Patient Name | Mr. SUBRIYOMAN | Contact No | 6290404407 |
| Address | 3/2 D.N MUKHERJEE ROAD , BAIDYABATI (M) | Age | 16 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 61 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||