Ticket for Outdoor Patient
| Ward No. 9 | U-PHC No. | Registration No. 04200 | Date 25/03/2021 |
| Token No | SM/25-26/2684 19/11/2025 | Serial | 009 |
| Patient Name | Mrs. JYOTI SHAW | Contact No | 7980998075 |
| Address | TINBAZAR | Age | 28 YRS Female |
| Token For | Visit Doctor,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||