Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03475 | Date 22/11/2019 |
| Token No | SM/21-22/2134 11/02/2022 | Serial | 004 |
| Patient Name | Mr. AMAN BARIK | Contact No | 8777631750 |
| Address | 45 N L BHATTACHARYA STREET | Age | 15 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||