Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04634 | Date 19/07/2021 |
| Token No | SM/21-22/673 19/07/2021 | Serial | 016 |
| Patient Name | Mr. SUJIT DEY | Contact No | NOT GIVEN |
| Address | 5B/C DEY STREET | Age | 46 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||