Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04521 | Date 23/06/2021 |
| Token No | SM/21-22/473 23/06/2021 | Serial | 003 |
| Patient Name | Mr. RAM BISWAS SHA | Contact No | 7890953937 |
| Address | 40 N L BHATTACHARYA STREET | Age | 49 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||