Ticket for Outdoor Patient
| Ward No. 25 | U-PHC No. | Registration No. 13782 | Date 26/11/2025 |
| Token No | SM/25-26/2780 26/11/2025 | Serial | 020 |
| Patient Name | Mr. SURESH DAS | Contact No | 9748326171 |
| Address | 1/P/17 RAILAND CIRCULAR ROAD | Age | 38 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||