Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 01506 | Date 28/04/2020 |
| Token No | SM/19-20/3966 28/04/2020 | Serial | 016 |
| Patient Name | Mrs. SURJUNA BIBI | Contact No | 6290382251 |
| Address | 33 MIYAJAN DARJI LANE MALLICKPARA SERAMPORE 712203 | Age | 30 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||