Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 11681 | Date 20/06/2024 |
| Token No | SM/25-26/2240 10/10/2025 | Serial | 008 |
| Patient Name | Mr. SUSHANTA KOLEY | Contact No | 9874250069 |
| Address | 16/1 DEY STREET | Age | 40 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||