Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 13426 | Date 29/08/2025 |
| Token No | SM/25-26/1786 29/08/2025 | Serial | 004 |
| Patient Name | Mr. DIPAK SHAW | Contact No | 9836300364 |
| Address | 9 DOSTI LANE, PALBAGAN | Age | 42 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||