Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 13306 | Date 28/07/2025 |
| Token No | SM/25-26/1416 28/07/2025 | Serial | 007 |
| Patient Name | Mr. MOHAN DAS | Contact No | 8240004833 |
| Address | 14 J.N. LAHIRI ROAD | Age | 66 YRS Male |
| Token For | Visit Doctor,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||