Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00030 | Date 03/08/2018 |
| Token No | SM/25-26/1366 24/07/2025 | Serial | 005 |
| Patient Name | Mrs. RADHA BARIK | Contact No | 8282932054 |
| Address | 45 N.L BHATTACHARYA ST | Age | 57 YRS Female |
| Token For | Visit Doctor,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||