Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 14815 | Date 28/08/2026 |
| Token No | SM/25-26/5611 28/08/2026 | Serial | 001 |
| Patient Name | Mr. TAPAN DOLUI | Contact No | 9874769467 |
| Address | 12 THAKURBATI STREET | Age | 56 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||