Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 05923 | Date 24/07/2019 |
| Token No | SM/19-20/14287 29/11/2019 | Serial | 056 Last Visit: 07/12/2020 |
| Patient Name | Mr. GOUTAM RAY | Contact No | 9051075728 |
| Address | 16 RAJA K.L GOSWAMI STREET SERAMPORE | Age | 7 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 17 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||