Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00210 | Date 20/09/2019 |
| Token No | SM/19-20/1351 02/01/2020 | Serial | 007 |
| Patient Name | Mrs. MANA DAS | Contact No | 9143191090 |
| Address | 12E MIYAJAN DARGEE LANE SERAMPORE 712203 | Age | 52 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | 120/80 mmHg | Weight | 65 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||