Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 13872 | Date 16/12/2025 |
| Token No | SM/25-26/3003 16/12/2025 | Serial | 003 |
| Patient Name | Mrs. KABITA SRIMANI | Contact No | 9836488195 |
| Address | 6 B BECHU DEY LANE | Age | 49 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||