Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 01178 | Date 14/03/2020 |
| Token No | SM/19-20/3074 14/03/2020 | Serial | 011 |
| Patient Name | Mrs. GULSAN ARA | Contact No | |
| Address | MIYAJAN DARJEE LANE SERAMPORE 712203 | Age | 29 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||