Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 04690 | Date 09/08/2021 |
| Token No | SM/21-22/782 09/08/2021 | Serial | 001 |
| Patient Name | Mr. DHARANI DAS | Contact No | 9836410878 |
| Address | PANCHANAN TALA LANE | Age | 72 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||