Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 09895 | Date 30/07/2021 |
| Token No | SM/21-22/3637 30/07/2021 | Serial | 021 Last Visit: 04/08/2021 |
| Patient Name | Mr. ASHOK DAS | Contact No | 9830647246 |
| Address | 4A DR. G.C. GOSWAMI STREET | Age | 45 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||