Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04354 | Date 04/05/2021 |
| Token No | SM/21-22/211 04/05/2021 | Serial | 009 |
| Patient Name | Mr. JAYDEB KOIRI | Contact No | 8961451363 |
| Address | 8 ACHARYA K C BHATTACHARJEE STREET | Age | 36 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||