Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00392 | Date 13/08/2018 |
| Token No | SM/18-19/431 13/08/2018 | Serial | 022 Last Visit: 13/08/2018 |
| Patient Name | Mr. SHIBAM DAS | Contact No | 8981587064 |
| Address | 4, SUDHIR CHANDRA ROY LANE | Age | 9.0 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 25 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||