Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03198 | Date 28/01/2019 |
| Token No | SM/18-19/7500 28/01/2019 | Serial | 003 Last Visit: 30/01/2019 |
| Patient Name | Mr. SUPRATIK DAS | Contact No | 7890608660 |
| Address | 162/D TELIPARA,BAGHER BAGAN,BAIDYABATY(M) | Age | 11 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 35 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||