Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05100 | Date 14/05/2019 |
| Token No | SM/19-20/2726 14/05/2019 | Serial | 040 Last Visit: 11/11/2019 |
| Patient Name | Mr. INSAN ALI | Contact No | 8240067054 |
| Address | 127B A.P GHOSH ROAD SERAMPORE | Age | 26 YRS Male |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 59 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||