Ticket for Outdoor Patient
| Ward No. 28 | U-PHC No. | Registration No. 00014 | Date 06/09/2019 |
| Token No | SM/19-20/1060 12/12/2019 | Serial | 001 |
| Patient Name | Miss ESITA DAS | Contact No | 9062547152 |
| Address | 171 RAJYADHARPUR GOVT COLONY MALLICKPARA SERAMPORE 712203 | Age | 14 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||