Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13052 | Date 24/05/2025 |
| Token No | SM/25-26/589 24/05/2025 | Serial | 049 |
| Patient Name | Miss POULAMI DAS | Contact No | 9007407023 |
| Address | 13 L M B STREET | Age | 16 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||