Ticket for Outdoor Patient
| Ward No. 21 | U-PHC No. | Registration No. 00571 | Date 18/12/2019 |
| Token No | SM/19-20/1686 20/01/2020 | Serial | 017 |
| Patient Name | Mrs. MITA SAHA | Contact No | 9831615572 |
| Address | 13 NAYAPATTY ROAD DUMDUM BANGUR AVENUE 700055 | Age | 58 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||