Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00185 | Date 17/09/2019 |
| Token No | SM/19-20/1402 04/01/2020 | Serial | 024 |
| Patient Name | Mrs. SHELLEY ADAK | Contact No | 9475100476 |
| Address | AMULYA KANAN HOUSING PHASE II,SERAMPORE 712203 | Age | 47 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||