Ticket for Outdoor Patient
| Ward No. 6 | U-PHC No. | Registration No. 01345 | Date 03/04/2020 |
| Token No | SM/25-26/12150 19/12/2025 | Serial | 014 |
| Patient Name | Mr. DEBOBRATA PATRA | Contact No | 8583997047 |
| Address | 5A JAMIDAR BAGAN LANE MALLICKPARA SERAMPORE 712203 | Age | 17 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||