Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 08682 | Date 28/08/2020 |
| Token No | SM/19-20/25280 28/08/2020 | Serial | 034 Last Visit: 28/08/2020 |
| Patient Name | Mr. SUMIT SHAW | Contact No | 9123894575 |
| Address | 10/A/Z/Y/E/F PAMPANAGAR,BAIDYABATI(M),DEEP PUKUR DAR | Age | 16 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||