Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00766 | Date 20/01/2020 |
| Token No | SM/19-20/1681 20/01/2020 | Serial | 012 |
| Patient Name | Mr. DEBATOSH DUTTA | Contact No | 9051152464 |
| Address | 65/20/A F D ROAD SERAMPORE 712203 | Age | 54 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | 60 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||