Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 03643 | Date 18/02/2019 |
| Token No | SM/18-19/8880 18/02/2019 | Serial | 053 Last Visit: 18/02/2019 |
| Patient Name | Mr. SUMAN NAYAK | Contact No | 9088703373 |
| Address | 39/105 DN MUKHREJEE ROAD CHATRA SERAMPOER | Age | 18 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 54 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||