Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13425 | Date 29/08/2025 |
| Token No | SM/25-26/1783 29/08/2025 | Serial | 001 |
| Patient Name | Mrs. PADMA MANNA | Contact No | |
| Address | PANDIT KALINATH BHATTACHARYA STREET | Age | 65 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||