Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 02718 | Date 28/12/2018 |
| Token No | SM/18-19/5955 29/12/2018 | Serial | 010 Last Visit: 29/12/2018 |
| Patient Name | Mr. DEBASIS ROY | Contact No | 9143222994 |
| Address | 96/3 R.K ROAD CHATRA MANNA PARA , BAIDYABATI(M) | Age | 63 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||