Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 01013 | Date 28/09/2018 |
| Token No | SM/18-19/2228 08/01/2019 | Serial | 009 |
| Patient Name | Mr. SAILA CHAKRABORTY | Contact No | 9830590177 |
| Address | KUMIRJALA ROAD SERAMPORE | Age | 72 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||