Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 05830 | Date 18/07/2019 |
| Token No | SM/19-20/6804 18/07/2019 | Serial | 079 Last Visit: 29/08/2019 |
| Patient Name | Mr. SAMIR KR. KARMOKAR | Contact No | 7450069924 |
| Address | 26 THAKUR DAS BABU LANE | Age | 55 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 67 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||