Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03432 | Date 19/11/2019 |
| Token No | SM/25-26/2475 03/11/2025 | Serial | 011 |
| Patient Name | Mrs. DEBIKA KOIRI | Contact No | 8961451363 |
| Address | 8 A K C BHATTACHARYA STREET | Age | 32 YRS Female |
| Token For | Visit Doctor,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||