Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 05907 | Date 24/05/2022 |
| Token No | SM/22-23/3069 24/05/2022 | Serial | 008 |
| Patient Name | Mr. DIPAK KUMAR SHEET | Contact No | 8017278346 |
| Address | 28/5 SHASHIBHUSAN GHOSH LANE | Age | 62 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||