Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 03123 | Date 21/01/2019 |
| Token No | SM/18-19/7227 21/01/2019 | Serial | 095 Last Visit: 12/02/2019 |
| Patient Name | Mr. MD AMIN ANSARI | Contact No | 9883023259 |
| Address | 32A TC GOSWAMI STREET | Age | 48 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 83 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||