Ticket for Outdoor Patient
| Ward No. 6 | U-PHC No. | Registration No. 00414 | Date 21/11/2019 |
| Token No | SM/19-20/768 21/11/2019 | Serial | 002 |
| Patient Name | Mrs. GITA DE | Contact No | 9681617070 |
| Address | 10/Q/2 HARIPARA LANE SERAMPORE 712203 | Age | 64 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 70 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||