Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00499 | Date 03/12/2019 |
| Token No | SM/19-20/2180 12/02/2020 | Serial | 016 |
| Patient Name | Mr. DR GOPAL CHANDRA MODAK | Contact No | 9830288502 |
| Address | A14/1 AMULYA KANAN HOUSING PH-2 SERAMPORE 712203 | Age | 58 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||