Ticket for Outdoor Patient
| Ward No. 27 | U-PHC No. | Registration No. 00215 | Date 21/09/2019 |
| Token No | SM/19-20/275 21/09/2019 | Serial | 014 |
| Patient Name | Miss SUBHASHREE SHIL | Contact No | 9874996269 |
| Address | 165/B CHAKLAPARA PRABASHNAGAR SERAMPORE 712249 | Age | 15 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | 19 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||