Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 06621 | Date 14/10/2019 |
| Token No | SM/19-20/11651 14/10/2019 | Serial | 045 Last Visit: 14/10/2019 |
| Patient Name | Mr. SK SARAPHAT | Contact No | 9038164940 |
| Address | 29/A CHATRA MUSALMAN PARA BYE LANE | Age | 60 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 51 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||