Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 05143 | Date 16/05/2019 |
| Token No | SM/19-20/2891 16/05/2019 | Serial | 053 Last Visit: 16/05/2019 |
| Patient Name | Mr. SANJAY DAS | Contact No | 9883023330 |
| Address | 22/A KUMIR JALA ROAD SERAMPORE | Age | 39 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 68 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||