Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04670 | Date 29/07/2021 |
| Token No | SM/21-22/740 29/07/2021 | Serial | 002 |
| Patient Name | Mr. SAMARESH PAL | Contact No | NOT GIVEN |
| Address | 5 RAM SITA LANE | Age | 80 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||