Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 01218 | Date 17/03/2020 |
| Token No | SM/19-20/3574 01/04/2020 | Serial | 015 |
| Patient Name | Mrs. FATEMA BIBI | Contact No | 8481034399 |
| Address | 32 MIYAJAN DARJEE LANE MALLICKPARA SERAMPORE 712203 | Age | 65 YRS Female |
| Token For | Visit Doctor,Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||