Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02759 | Date 31/12/2018 |
| Token No | SM/18-19/6044 31/12/2018 | Serial | 043 Last Visit: 31/12/2018 |
| Patient Name | Mr. ASHOK CHUNARI | Contact No | 9051826460 |
| Address | 196/1 TELI PARA ,BAGER BAGAN,BAIDYABATY (M) | Age | 59 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||