Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04286 | Date 18/03/2019 |
| Token No | SM/19-20/3081 21/05/2019 | Serial | 029 Last Visit: 21/05/2019 |
| Patient Name | Mr. PANCHU GOPAL MAITY | Contact No | 8585074130 |
| Address | 57/J/I, GT ROAD CHATRA PAMPA NAGAR CHATRA , BAIDYABATI(M) | Age | 50 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 70 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||