Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 07018 | Date 29/11/2019 |
| Token No | SM/19-20/14315 29/11/2019 | Serial | 084 Last Visit: 29/12/2020 |
| Patient Name | Mr. SUDAM SOM | Contact No | 9883194616 |
| Address | 69 CHATRA BARUI PARA LANE SERAMPORE | Age | 50 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 56 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||