Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 04868 | Date 23/04/2019 |
| Token No | SM/19-20/1500 23/04/2019 | Serial | 081 Last Visit: 23/04/2019 |
| Patient Name | Mr. SURYA DAS | Contact No | 9830309916 |
| Address | 18 RAJA K.L GOSWAMI STREET SERAMPORE | Age | 29 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 67 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||