Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 05046 | Date 12/11/2021 |
| Token No | SM/21-22/1387 12/11/2021 | Serial | 012 |
| Patient Name | Mr. GOUTAM DAS | Contact No | 9007685908 |
| Address | 5 BHAGIRATHI LANE | Age | 50 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||