Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13875 | Date 16/12/2025 |
| Token No | SM/25-26/3009 16/12/2025 | Serial | 009 |
| Patient Name | Mr. MD RAJA | Contact No | 9007598523 |
| Address | 21 N.L. BHATTACHARYA STREET | Age | 32 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||