Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05505 | Date 21/06/2019 |
| Token No | SM/19-20/5004 21/06/2019 | Serial | 030 Last Visit: 04/03/2020 |
| Patient Name | Mr. BHOLANATH SIL | Contact No | 7980955256 |
| Address | NABAGRAM VIVEKANANDA SARANI, BAIDYBATI(M) | Age | 40 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||