Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00021 | Date 06/09/2019 |
| Token No | SM/19-20/21 06/09/2019 | Serial | 018 |
| Patient Name | Mrs. KASHMIRA BEGUM | Contact No | 8961129410 |
| Address | 26/A MIYAJAN DARJEE LANE MALLICKPARA SERAMPORE 712203 | Age | 55 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | 124/90 mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||