Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05394 | Date 12/06/2019 |
| Token No | SM/19-20/4402 12/06/2019 | Serial | 001 Last Visit: 12/06/2019 |
| Patient Name | Mr. MUJIBAR RAHAMAN | Contact No | 9081217654 |
| Address | 17/2/A/2 MUSALMAN PRA BYE LANE SERAMPORE | Age | 38 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 69.5 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||