Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01540 | Date 03/01/2019 |
| Token No | SM/25-26/2193 08/10/2025 | Serial | 012 |
| Patient Name | Mr. TIRUPATI BISWAL | Contact No | 9836010315 |
| Address | 9 INDIA JUTE MILL | Age | 44 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||