Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 01608 | Date 10/10/2018 |
| Token No | SM/18-19/2714 10/10/2018 | Serial | 039 Last Visit: 23/04/2019 |
| Patient Name | Mr. SAYAN DAS | Contact No | 7595029834 |
| Address | 25A CHATRA DHARMOTALA LANE | Age | 15 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 65 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||