Ticket for Outdoor Patient
| Ward No. 28 | U-PHC No. | Registration No. 00068 | Date 09/09/2019 |
| Token No | SM/19-20/591 05/11/2019 | Serial | 059 |
| Patient Name | Mr. SHAMBHUNATH DAS | Contact No | 9748005678 |
| Address | 98 Y TARAPUKUR LANE MALLICKPARA SERAMPORE 712203 | Age | 71 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||