Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03857 | Date 25/02/2020 |
| Token No | SM/22-23/5247 21/09/2022 | Serial | 019 |
| Patient Name | Mr. MADAN MOHON KOLEY | Contact No | 9903862723 |
| Address | PANCHANAN TALA LANE | Age | 67 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||