Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03616 | Date 16/01/2023 |
| Token No | SM/22-23/6138 16/01/2023 | Serial | 029 |
| Patient Name | Mr. DEEP DAS | Contact No | 8013957360 |
| Address | 23/36/A G T ROAD GODAR BAGAN BYE LANE CHATRA BAIDYABATI M 712204 | Age | 8 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 16 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||