Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00175 | Date 17/09/2019 |
| Token No | SM/19-20/388 30/09/2019 | Serial | 012 |
| Patient Name | Mr. SK GAFFAR | Contact No | 9748031997 |
| Address | 88A MIYAJAN DARJEE LANE MALLICKPARA SERAMPORE 712203 | Age | 78 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||