Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 06192 | Date 21/08/2019 |
| Token No | SM/19-20/13970 25/11/2019 | Serial | 079 Last Visit: 25/11/2019 |
| Patient Name | Mr. GAUTAM SOM | Contact No | 9433104407 |
| Address | 19 CHATRA DHARMOTALA LANE SERAMPORE | Age | 63 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 57 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||