Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04295 | Date 19/04/2021 |
| Token No | SM/21-22/104 19/04/2021 | Serial | 017 |
| Patient Name | Mr. SUMANTA GHOSH | Contact No | 8697354187 |
| Address | 52 LALIT MOHON BHATTACHARJEE STREET | Age | 42 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||