Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 03065 | Date 18/01/2019 |
| Token No | SM/20-21/30350 04/03/2021 | Serial | 026 Last Visit: 22/10/2025 |
| Patient Name | Mr. GOUTAM SOM | Contact No | 9330017666 |
| Address | 69 CHATRA BARUIPARA LANE | Age | 62 Years,9 Months,20 Days Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||