Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 13880 | Date 19/12/2025 |
| Token No | SM/25-26/3048 19/12/2025 | Serial | 004 |
| Patient Name | Mr. RAM UJAGIR SHAW | Contact No | 9903873822 |
| Address | DEY STREET | Age | 60 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||