Ticket for Outdoor Patient
| Ward No. 6 | U-PHC No. | Registration No. 00163 | Date 16/09/2019 |
| Token No | SM/22-23/4994 05/12/2022 | Serial | 048 |
| Patient Name | Miss FIRDOS KHATOON | Contact No | 9163350062 |
| Address | 4 TARAPUKUR LANE CHAKAPARA MALLICKPARA SERAMPORE 712203 | Age | 8 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 19 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||