Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 13312 | Date 28/07/2025 |
| Token No | SM/25-26/1427 28/07/2025 | Serial | 018 |
| Patient Name | Mr. BALESWAR PADIARI. | Contact No | 9748923835 |
| Address | 19 DOSTI LANE | Age | 45 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||