Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 06245 | Date 28/08/2019 |
| Token No | SM/19-20/9289 28/08/2019 | Serial | 012 Last Visit: 28/08/2019 |
| Patient Name | Mr. FOKO MIDDEY | Contact No | 9073525180 |
| Address | 131/A TELIPARA BAGER BAGAN , BAIDYABATI (M) | Age | 58 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 66 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||