Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02565 | Date 17/12/2018 |
| Token No | SM/18-19/5376 17/12/2018 | Serial | 057 Last Visit: 17/12/2018 |
| Patient Name | Mr. AMAL MAJUMDAR | Contact No | 9830714003 |
| Address | 3 JAL TANK RISHRA (M) | Age | 55 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||