Ticket for Outdoor Patient
| Ward No. 29 | U-PHC No. | Registration No. 01354 | Date 04/04/2020 |
| Token No | SM/25-26/12259 22/12/2025 | Serial | 019 |
| Patient Name | Mr. SUNDARAM GUPTA | Contact No | 9163247576 |
| Address | 43/39/B/5 PRAVASHNAGAR SERAMPORE 712249 | Age | 14 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||