Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00044 | Date 09/09/2019 |
| Token No | SM/19-20/3625 04/04/2020 | Serial | 004 |
| Patient Name | Mrs. MONA DAS | Contact No | 9143191090 |
| Address | MIYAJAN DARJEE LANE MALLICKPARA SERAMPORE 712203 | Age | 48 YRS Female |
| Token For | Visit Doctor,Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||