Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 09078 | Date 17/05/2023 |
| Token No | SM/25-26/1099 07/07/2025 | Serial | 003 |
| Patient Name | Mrs. PURNIMA DAS | Contact No | |
| Address | 19 DOSTI LANE | Age | 47 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||