Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00502 | Date 04/12/2019 |
| Token No | SM/19-20/1858 28/01/2020 | Serial | 013 |
| Patient Name | Miss JYOTI SHAW | Contact No | 9804669250 |
| Address | CHAKLAPARA,PRABASHNAGAR SERAMPORE 712249 | Age | 18 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | 28 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||