Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13574 | Date 08/10/2025 |
| Token No | SM/25-26/2196 08/10/2025 | Serial | 015 |
| Patient Name | Mr. AJAY GUPTA | Contact No | 9062375128 |
| Address | 30 DR. N.L. BHATTACHARYA STREET | Age | 35 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||