Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01961 | Date 14/11/2018 |
| Token No | SM/18-19/3679 14/11/2018 | Serial | 068 Last Visit: 14/11/2018 |
| Patient Name | Mr. PRABUDDHA CHAKRABORTY | Contact No | 8961170850 |
| Address | 41 L M BHATTACHRYA STREET | Age | 26 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 59 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||