Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 04638 | Date 22/07/2021 |
| Token No | SM/21-22/1210 29/09/2021 | Serial | 004 |
| Patient Name | Mr. BINOD DAS | Contact No | NOT GIVEN |
| Address | 573 G T ROAD, MANIKTALA | Age | 70 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||