Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00511 | Date 05/12/2019 |
| Token No | SM/19-20/979 05/12/2019 | Serial | 006 |
| Patient Name | Mrs. SIDDIKA BEGAM | Contact No | 9231965453 |
| Address | 26/2 MIAJAN DARJEE LANE MALLICKPARA SERAMPORE 712203 | Age | 31 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||