Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 06221 | Date 26/08/2019 |
| Token No | SM/19-20/9124 26/08/2019 | Serial | 040 Last Visit: 26/08/2019 |
| Patient Name | Mr. NIMAI CHANDRA PAL | Contact No | 8697302662 |
| Address | 301/G/F/, TELI PARA , BAGER BAGAN , CHATRA , BAIDYABATI(M) | Age | 44 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 50 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||