Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 02757 | Date 31/12/2018 |
| Token No | SM/18-19/6035 31/12/2018 | Serial | 034 Last Visit: 31/12/2018 |
| Patient Name | Mr. AMER NATH PAUL | Contact No | |
| Address | 46 DR. G C GOSWAMI STREET | Age | 72 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 60 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||