Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13905 | Date 31/12/2025 |
| Token No | SM/25-26/3123 31/12/2025 | Serial | 003 |
| Patient Name | Mr. ABHIJIT SRIMANI | Contact No | 9433733695 |
| Address | 14C DEY STREET | Age | 52 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||