Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00418 | Date 21/11/2019 |
| Token No | SM/19-20/778 21/11/2019 | Serial | 012 |
| Patient Name | Mr. PRATIP BANERJEE | Contact No | 9163007121 |
| Address | 29/A MALLICKPARA SERAMPORE 712203 | Age | 23 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||