Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05987 | Date 29/07/2019 |
| Token No | SM/19-20/7491 29/07/2019 | Serial | 027 Last Visit: 29/07/2019 |
| Patient Name | Mr. SURAJ SHAW | Contact No | 9143231344 |
| Address | 281/B/A/1 GHOSAL PARA NABAGARAM, BAIDYABATI(M) | Age | 14 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||