Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02818 | Date 04/01/2019 |
| Token No | SM/18-19/6253 04/01/2019 | Serial | 038 Last Visit: 14/01/2019 |
| Patient Name | Mr. MENTU BHALLA | Contact No | 6291205862 |
| Address | CHATRA TETUL TALA,BAIDYABATY(M) | Age | 16 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||