Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02126 | Date 26/11/2018 |
| Token No | SM/18-19/4158 26/11/2018 | Serial | 031 Last Visit: 26/11/2018 |
| Patient Name | Mr. MONTA BAGCHI | Contact No | 9836515118 |
| Address | 18 NO HORIMOHAN GOSWAMI STREET | Age | 11 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||