Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 07040 | Date 14/09/2022 |
| Token No | SM/22-23/5119 14/09/2022 | Serial | 018 |
| Patient Name | Mr. MOLOY SEN | Contact No | 9903757734 |
| Address | 39 PANDIT KALINATH BHATTACHARJEE STREET | Age | 42 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||