Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 14981 | Date 26/10/2026 |
| Token No | SM/25-26/6061 26/10/2026 | Serial | 011 |
| Patient Name | Mrs. SARITA DEBI | Contact No | 9711716321 |
| Address | 7/343 COCKRAIN ROAD | Age | 27 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||