Ticket for Outdoor Patient
| Ward No. 28 | U-PHC No. | Registration No. 00164 | Date 16/09/2019 |
| Token No | SM/19-20/179 16/09/2019 | Serial | 043 |
| Patient Name | Mrs. SREEPARNA DAS | Contact No | 9748005678 |
| Address | B/98/Y TARAPUKUR GOVT QUARTER MALLICKPARA SERAMPORE 712203 | Age | 16 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | 14 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||