Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 05120 | Date 15/05/2019 |
| Token No | SM/19-20/2805 15/05/2019 | Serial | 045 Last Visit: 15/05/2019 |
| Patient Name | Mr. DEEP MALAKAR | Contact No | 9836267739 |
| Address | 16/18 GD BHATTACHARJEE LANE CHATRA , BIADYABATI(M) | Age | 5 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 13 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||