Ticket for Outdoor Patient
| Ward No. 6 | U-PHC No. | Registration No. 00017 | Date 06/09/2019 |
| Token No | SM/19-20/734 19/11/2019 | Serial | 014 |
| Patient Name | Mrs. MINA RANI PODDER | Contact No | 9883262063 |
| Address | 10/3 HARIPARA LANE MALLICKPARA SERAMPORE 712203 | Age | 75 YRS Female |
| Token For | Visit Doctor,Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||