Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 04290 | Date 19/04/2021 |
| Token No | SM/21-22/95 19/04/2021 | Serial | 008 |
| Patient Name | Mr. SAMBHUNATH MONDAL | Contact No | NOT GIVEN |
| Address | 10 CHOWDHURY PARA LANE | Age | 86 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||