Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 04617 | Date 15/07/2021 |
| Token No | SM/21-22/639 15/07/2021 | Serial | 013 |
| Patient Name | Mr. SUDHAMAY JAISWARA | Contact No | NOT GIVEN |
| Address | 7 DEY GHAT LANE | Age | 53 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||