Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13205 | Date 05/07/2025 |
| Token No | SM/25-26/1095 05/07/2025 | Serial | 001 |
| Patient Name | Mr. ASHOK SWAIN. | Contact No | 9836218119 |
| Address | 12 NO. LINE, INDIA JUTE MILL | Age | 53 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||