Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 03865 | Date 04/03/2020 |
| Token No | SM/21-22/713 26/07/2021 | Serial | 007 |
| Patient Name | Mrs. MINOTI MODOK | Contact No | NOT GIVEN |
| Address | KALITALA, SERAMPORE | Age | 56 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||