Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02594 | Date 19/12/2018 |
| Token No | SM/18-19/5459 19/12/2018 | Serial | 023 Last Visit: 24/10/2019 |
| Patient Name | Mr. SUSHOMAN PRAMANIK | Contact No | 9830289833 |
| Address | 95/38 A/A CHATRA TETULTALA GT ROAD | Age | 15 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 53.5 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||