Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 01251 | Date 20/03/2020 |
| Token No | SM/19-20/3317 20/03/2020 | Serial | 035 |
| Patient Name | Mrs. NURJAHAN BIBI | Contact No | 9123695746 |
| Address | 18/A MIYAJAN DARJI LANE MALLICKPARA SERAMPORE 712203 | Age | 66 YRS Female |
| Token For | Visit Doctor,Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||