Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 02777 | Date 31/12/2018 |
| Token No | SM/18-19/6091 31/12/2018 | Serial | 090 Last Visit: 31/12/2018 |
| Patient Name | Mr. GOUTAM DUTTA | Contact No | 9830934789 |
| Address | 30/A DR. BAGAN LANE | Age | 68 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||