Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 07170 | Date 16/12/2019 |
| Token No | SM/19-20/15438 16/12/2019 | Serial | 102 Last Visit: 16/12/2019 |
| Patient Name | Mr. PRADIP MODAK | Contact No | 9903130315 |
| Address | 236 SADGOPE PARA LANE (VIVEKANAND SARANI ) SERAMPORE | Age | 56 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 65 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||