Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 12911 | Date 23/04/2025 |
| Token No | SM/25-26/3084 22/12/2025 | Serial | 022 |
| Patient Name | Mr. JANKI SHAW | Contact No | 7595858456 |
| Address | 43 BHAGIRATHI LANE | Age | 74 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||