Ticket for Outdoor Patient
| Ward No. 27 | U-PHC No. | Registration No. 00687 | Date 08/01/2020 |
| Token No | SM/19-20/1664 18/01/2020 | Serial | 014 |
| Patient Name | Mrs. CHAMPA KARMAKAR | Contact No | 9143210790 |
| Address | 9/1/C/66 M J ROAD MALLICKPARA SERAMPORE 712203 | Age | 58 Female |
| Token For | Visit Doctor,Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||