Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13428 | Date 29/08/2025 |
| Token No | SM/25-26/1788 29/08/2025 | Serial | 006 |
| Patient Name | Mr. JITENDRA PRASAD | Contact No | 8100678522 |
| Address | 30 DR. N.L. BHATTACHARYA STREET | Age | 40 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||