Ticket for Outdoor Patient
| Ward No. 8 | U-PHC No. | Registration No. 00295 | Date 23/10/2019 |
| Token No | SM/19-20/462 23/10/2019 | Serial | 004 |
| Patient Name | Mrs. DURGA MODAK | Contact No | 9051487963 |
| Address | 11B SANNYAL LANE SERAMPORE | Age | 48 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||