Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 13541 | Date 19/09/2025 |
| Token No | SM/25-26/2112 19/09/2025 | Serial | 001 |
| Patient Name | Mrs. PUNAM DEBI | Contact No | |
| Address | 126 R.B. SARANI | Age | 36 YRS Female |
| Token For | Visit Doctor,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||