Ticket for Outdoor Patient
| Ward No. 6 | U-PHC No. | Registration No. 00163 | Date 16/09/2019 |
| Token No | SM/19-20/178 16/09/2019 | Serial | 042 |
| Patient Name | Miss FIRDOS KHATOON | Contact No | 9163350062 |
| Address | 4 TARAPUKUR LANE CHAKAPARA MALLICKPARA SERAMPORE 712203 | Age | 8 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | 15 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||