Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00533 | Date 11/12/2019 |
| Token No | SM/19-20/3113 16/03/2020 | Serial | 013 |
| Patient Name | Mr. SK SAMSER ALI | Contact No | 9088500125 |
| Address | 30/A MALLICKPARA MIYAJAN DARJEE LANE SERAMPORE 712203 | Age | 74 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | 50 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||