Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 03102 | Date 21/01/2019 |
| Token No | SM/18-19/7141 21/01/2019 | Serial | 009 Last Visit: 21/01/2019 |
| Patient Name | Mr. SURAJIT DAS | Contact No | 9674779801 |
| Address | 66 CHATRA DHARMOTALA | Age | 25 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 50 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||