Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 02497 | Date 12/12/2018 |
| Token No | SM/21-22/214 06/04/2021 | Serial | 058 Last Visit: 31/01/2022 |
| Patient Name | Mr. GOUTAM DAS | Contact No | 9874922647 |
| Address | 49/19/FCHATRA SITALA TALA GURU DAS BHATTACHARJEE LANE BAIDHYABATI | Age | 53 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||