Ticket for Outdoor Patient
| Ward No. 25 | U-PHC No. | Registration No. 00114 | Date 13/09/2019 |
| Token No | SM/19-20/1309 30/12/2019 | Serial | 012 |
| Patient Name | Mrs. CHANCHALA DAS | Contact No | 9804866659 |
| Address | 12/O JANNAGAR ROAD SERAMPORE M MAHESH 1 712202 | Age | 56 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 22 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||