Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 04804 | Date 22/04/2019 |
| Token No | SM/19-20/1431 23/04/2019 | Serial | 012 Last Visit: 23/04/2019 |
| Patient Name | Mr. SK SAMSER | Contact No | |
| Address | 21 CHATRA MUSALMAN PARA BYE LANE SERAMPORE | Age | 50 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||