Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 06414 | Date 16/09/2019 |
| Token No | SM/19-20/10400 16/09/2019 | Serial | 001 Last Visit: 16/09/2019 |
| Patient Name | Mr. SANKAR MODAK | Contact No | 9674512180 |
| Address | CHATRA TENTULTALA , BAIDYABATI(M) | Age | 42 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 50 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||