Ticket for Outdoor Patient
| Ward No. 7 | U-PHC No. | Registration No. 02632 | Date 21/12/2018 |
| Token No | SM/18-19/5580 21/12/2018 | Serial | 030 Last Visit: 30/11/2019 |
| Patient Name | Mr. SUMAN BANIK | Contact No | 7449836431 |
| Address | 13 ROY GHAT LANE | Age | 17 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 66 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||