Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01967 | Date 14/11/2018 |
| Token No | SM/18-19/3694 14/11/2018 | Serial | 083 Last Visit: 19/11/2018 |
| Patient Name | Mr. SAMBHUNATH GHOSAL | Contact No | |
| Address | 13 K C BHATTACHARYA STREET | Age | 42 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | 120/80 mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||