Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04473 | Date 11/06/2021 |
| Token No | SM/22-23/9720 19/05/2023 | Serial | 042 |
| Patient Name | Mr. JIBAN DEY | Contact No | NOT GIVEN |
| Address | 75 DEY STREET | Age | 67 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||