Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 09111 | Date 29/12/2020 |
| Token No | SM/20-21/28893 29/12/2020 | Serial | 037 Last Visit: 03/02/2021 |
| Patient Name | Mr. GOSTA BIHARI KOLEY | Contact No | 9836654158 |
| Address | 29 JELE PARA LANE NABAGRAM, BAIDYABATI(M) | Age | 70 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||