Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 13103 | Date 12/06/2025 |
| Token No | SM/25-26/2209 09/10/2025 | Serial | 010 |
| Patient Name | Mr. SUBIR MODOK | Contact No | 7718432511 |
| Address | DEY GHAT LANE | Age | 60 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||