Ticket for Outdoor Patient
| Ward No. 25 | U-PHC No. | Registration No. 00420 | Date 23/11/2019 |
| Token No | SM/19-20/783 23/11/2019 | Serial | 004 |
| Patient Name | Mr. GOPAL ROY | Contact No | 8961143890 |
| Address | 3/172 MAHESH COLONY SERAMPORE 712202 | Age | 48 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||