Ticket for Outdoor Patient
| Ward No. 28 | U-PHC No. | Registration No. 00226 | Date 23/09/2019 |
| Token No | SM/19-20/291 23/09/2019 | Serial | 010 |
| Patient Name | Mrs. MOMOTA SIL | Contact No | 9230276045 |
| Address | TARA PUKUR LANE MALLICKPARA SERAMPORE 712203 | Age | 30 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | 49 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||