Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 01110 | Date 13/09/2018 |
| Token No | SM/18-19/7382 24/01/2019 | Serial | 069 Last Visit: 01/06/2019 |
| Patient Name | Mr. SUBHAM DAS | Contact No | 8420883432 |
| Address | 27/B A.P GHOSH ROAD CHATRA SERAMPORE | Age | 15 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 79 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||