Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01667 | Date 13/10/2018 |
| Token No | SM/18-19/2879 13/10/2018 | Serial | 033 Last Visit: 13/10/2018 |
| Patient Name | Mr. SURYO DAS | Contact No | 9830309916 |
| Address | 18 RAJA K L GOSWAMI STREET | Age | 29 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 66 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||