Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 01764 | Date 29/10/2018 |
| Token No | SM/19-20/7296 25/07/2019 | Serial | 049 Last Visit: 26/03/2020 |
| Patient Name | Mr. SOUMYAJIT SOM | Contact No | 9874330728 |
| Address | 124/A CHATRA BARUI PARA | Age | 14 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 28 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||