Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00219 | Date 23/09/2019 |
| Token No | SM/19-20/283 23/09/2019 | Serial | 002 |
| Patient Name | Mrs. MOHORJAN BIBI | Contact No | 9007080785 |
| Address | 23 MIYAJAN DARJI LANE MALLICKPARA SERAMPORE 712203 | Age | 55 YRS Female |
| Token For | Visit Doctor,Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||