Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02804 | Date 03/01/2019 |
| Token No | SM/18-19/6934 17/01/2019 | Serial | 014 Last Visit: 17/01/2019 |
| Patient Name | Mr. NILU DAS | Contact No | 9007802627 |
| Address | 27 CHATRA MUSALMAN PARA | Age | 50 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 59 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||