Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 02039 | Date 19/11/2018 |
| Token No | SM/18-19/3902 19/11/2018 | Serial | 069 Last Visit: 19/11/2018 |
| Patient Name | Mr. GOUTAM KARMOKAR | Contact No | 9836556372 |
| Address | 27A GURU DAS BHATTCHARYA LANE CHATRA , BAIDYABATI(M) | Age | 50 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 60 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||