Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 13747 | Date 18/11/2025 |
| Token No | SM/25-26/2670 18/11/2025 | Serial | 009 |
| Patient Name | Miss MONA DAS | Contact No | 6289750522 |
| Address | 14/C DEY STREET | Age | 17 YRS Female |
| Token For | Visit Doctor,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||