Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04536 | Date 28/06/2021 |
| Token No | SM/21-22/500 28/06/2021 | Serial | 001 |
| Patient Name | Mr. KRIPA NATH DEY | Contact No | NOT GIVEN |
| Address | 27 JANNAGAR ROAD | Age | 48 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||