Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 13266 | Date 22/07/2025 |
| Token No | SM/25-26/1320 22/07/2025 | Serial | 005 |
| Patient Name | Mrs. RINA JANA | Contact No | 7980498858 |
| Address | 5 DOSTI LANE | Age | 48 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||