Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 13727 | Date 13/11/2025 |
| Token No | SM/25-26/2599 13/11/2025 | Serial | 001 |
| Patient Name | Mr. RAJKUMAR SHAW | Contact No | |
| Address | 79 DEY STREET | Age | 45 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||