Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13640 | Date 18/10/2025 |
| Token No | SM/25-26/2342 18/10/2025 | Serial | 015 |
| Patient Name | Mr. SHAMBHUNATH KURMI | Contact No | 8013169542 |
| Address | 18 NO LINE, DHARMATALA | Age | 65 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||