Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 00147 | Date 06/08/2018 |
| Token No | SM/18-19/7143 21/01/2019 | Serial | 011 Last Visit: 06/07/2019 |
| Patient Name | Mr. SURJA KANTA DAS | Contact No | 9674779801 |
| Address | 66, CHATRA DHARMOTALA | Age | 58 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 50 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||