Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 00923 | Date 05/09/2018 |
| Token No | SM/18-19/2071 25/09/2018 | Serial | 053 Last Visit: 27/10/2018 |
| Patient Name | Mr. JAHARLAL BANERJEE | Contact No | |
| Address | 22 DHARMATALA LANE | Age | 66 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 65 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||