Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 04677 | Date 12/04/2019 |
| Token No | SM/19-20/7820 02/08/2019 | Serial | 052 Last Visit: 06/09/2021 |
| Patient Name | Mr. CHOTU SHAW | Contact No | 9143231344 |
| Address | 281/B/A/1 GHOSAL PARA NABAGRAM, BAIDYABATI(M) | Age | 40 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||