Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13630 | Date 18/10/2025 |
| Token No | SM/25-26/2328 18/10/2025 | Serial | 001 |
| Patient Name | Mr. SHIB SANKAR ROY | Contact No | 9088502037 |
| Address | 12 RAM SITA LANE | Age | 54 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||