Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00328 | Date 05/11/2019 |
| Token No | SM/19-20/1859 28/01/2020 | Serial | 014 |
| Patient Name | Miss SHANTI SHAW | Contact No | 9804669250 |
| Address | GHORAMARA PURBAPARA SERAMPORE 712203 | Age | 11 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | 16 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||