Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 03364 | Date 04/02/2019 |
| Token No | SM/19-20/5813 02/07/2019 | Serial | 103 Last Visit: 02/07/2019 |
| Patient Name | Mr. SAYAN DE | Contact No | 8820344589 |
| Address | 4 CHOWDHURY PARA LANE | Age | 18 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 79 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||