Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00885 | Date 07/02/2020 |
| Token No | SM/19-20/3635 04/04/2020 | Serial | 014 |
| Patient Name | Mrs. MOSLEMA BIBI | Contact No | 7685044192 |
| Address | 18/A MIYAJAN DARJEE LANE MALLICKPARA SERAMPORE 712203 | Age | 39 YRS Female |
| Token For | Visit Doctor,Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||