Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00282 | Date 22/10/2019 |
| Token No | SM/19-20/3506 28/03/2020 | Serial | 029 |
| Patient Name | Mrs. MONOWARA BEGUM | Contact No | 9830681972 |
| Address | 1 CHELEKHANA ROAD MALLICKPARA SERAMPORE 712203 | Age | 49 YRS Female |
| Token For | Visit Doctor,Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||