Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 13865 | Date 13/12/2025 |
| Token No | SM/25-26/2991 13/12/2025 | Serial | 007 |
| Patient Name | Miss KOYEL DAS | Contact No | 8207000470 |
| Address | 60 DEY STREET | Age | 15 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||