Ticket for Outdoor Patient
| Ward No. 6 | U-PHC No. | Registration No. 00135 | Date 16/09/2019 |
| Token No | SM/19-20/498 26/10/2019 | Serial | 011 |
| Patient Name | Mrs. MIRA DHUL | Contact No | 8820742677 |
| Address | 23E MIYAJAN DARJEE LANE MALLICKPARA,SERAMPORE 712203 | Age | 68 YRS Female |
| Token For | Visit Doctor,Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||