Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 05387 | Date 11/06/2019 |
| Token No | SM/19-20/4379 11/06/2019 | Serial | 055 Last Visit: 11/06/2019 |
| Patient Name | Mr. SURAJIT DAS | Contact No | 9681248032 |
| Address | 184/2 CHATRA LANKAR BAGAN SACHTASHI PARA , BAIDYABATI(M) | Age | 15 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 53 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||