Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13881 | Date 19/12/2025 |
| Token No | SM/25-26/3050 19/12/2025 | Serial | 006 |
| Patient Name | Mr. NANDALAL RAI | Contact No | 8478967423 |
| Address | 26 KC BHATTACHARYA STREET | Age | 60 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||