Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 05150 | Date 14/12/2021 |
| Token No | SM/22-23/3169 30/05/2022 | Serial | 008 |
| Patient Name | Mr. GOPAL ADAK | Contact No | 9038422654 |
| Address | 18 AKHRA BATI LANE | Age | 45 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||