Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04987 | Date 26/10/2021 |
| Token No | SM/21-22/1277 26/10/2021 | Serial | 001 |
| Patient Name | Mr. PACHU GOPAL KARMAKAR | Contact No | 7439082781 |
| Address | 56 DHULIPARA | Age | 67 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||