Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 09075 | Date 18/12/2020 |
| Token No | SM/20-21/28583 18/12/2020 | Serial | 031 Last Visit: 18/12/2020 |
| Patient Name | Mr. SURESH TANTI | Contact No | 9831825297 |
| Address | 295/4 PERPUR ROD VIDYASAGAR PALLY, SHEORAPHULI, BAIDYABATI(M) | Age | 43 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||