Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 13737 | Date 17/11/2025 |
| Token No | SM/25-26/2649 17/11/2025 | Serial | 013 |
| Patient Name | Mrs. SOUMI MODAK | Contact No | 9733478871 |
| Address | 43 G.T. ROAD, MADAM BAGAN | Age | 25 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||