Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 13417 | Date 27/08/2025 |
| Token No | SM/25-26/1752 27/08/2025 | Serial | 006 |
| Patient Name | Mr. MADHUSUDAN SWAIN | Contact No | NOT GIVEN |
| Address | 12 PITAMBAR DEY LANE | Age | 37 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||