Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04436 | Date 28/03/2019 |
| Token No | SM/19-20/57 01/04/2019 | Serial | 058 Last Visit: 16/04/2019 |
| Patient Name | Mr. ASHOK KUMAR BAG | Contact No | 9674275239 |
| Address | 162/A BAGER BAGAN TELI PARA CHATRA , BAIDYABATI(M) | Age | 56 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||