Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04654 | Date 23/07/2021 |
| Token No | SM/21-22/706 23/07/2021 | Serial | 016 |
| Patient Name | Mr. JAYANTA SRIMANI | Contact No | 7003521625 |
| Address | DEY STREET | Age | 31 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||