Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04636 | Date 19/07/2021 |
| Token No | SM/21-22/676 19/07/2021 | Serial | 019 |
| Patient Name | Mr. SOBHON DAS | Contact No | NOT GIVEN |
| Address | 41 N.L. BHATTACHARYA ST | Age | 18 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||