Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 09116 | Date 31/12/2020 |
| Token No | SM/20-21/29010 05/01/2021 | Serial | 026 Last Visit: 09/04/2021 |
| Patient Name | Mr. NEMAI CHANDRA GUIN | Contact No | 9231662552 |
| Address | 72(31/1/3)G. T. ROAD,GODAR BAGAN,BAIDYABATI(M) | Age | 66 YRS Male |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||