Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04967 | Date 29/04/2019 |
| Token No | SM/21-22/10791 15/03/2022 | Serial | 011 Last Visit: 11/07/2023 |
| Patient Name | Mr. GOUTAM JANA | Contact No | |
| Address | 166 BAGHER BAGAN TALI PARA | Age | 54 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||