Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 05188 | Date 22/12/2021 |
| Token No | SM/21-22/1711 22/12/2021 | Serial | 011 |
| Patient Name | Mr. GOPAL DEBNATH | Contact No | 8697358578 |
| Address | 26 AKHRA BATI LANE | Age | 51 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||