Ticket for Outdoor Patient
| Ward No. 28 | U-PHC No. | Registration No. 01580 | Date 07/07/2020 |
| Token No | SM/19-20/4113 07/07/2020 | Serial | 005 |
| Patient Name | Mrs. KUNTALA CHAKROBORTY | Contact No | 9339883337 |
| Address | B/79/X TARAPUKUR GOVT QUARTER MALLICKPARA SERAMPORE 712203 | Age | 53 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||