Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02661 | Date 24/12/2018 |
| Token No | SM/18-19/5761 27/12/2018 | Serial | 019 Last Visit: 05/01/2019 |
| Patient Name | Mr. SASANKA SEKHAR DAS | Contact No | 9933629675 |
| Address | HARIPAL,CHOKONANTO | Age | 68 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||