Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 12375 | Date 23/11/2024 |
| Token No | SM/25-26/1398 25/07/2025 | Serial | 011 |
| Patient Name | Mr. OMNATH ROY | Contact No | 8697613975 |
| Address | 55 RAYLAND ROAD | Age | 15 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||