Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00001 | Date 05/09/2019 |
| Token No | SM/19-20/1 05/09/2019 | Serial | 001 |
| Patient Name | Mrs. PURNIMA CHITRAKAR | Contact No | 7449461837 |
| Address | 24 MIYAJAN DARJI LANE MALLICKPARA SERAMPORE 712203 | Age | 21 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | 100/70 mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||