Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 14988 | Date 27/10/2026 |
| Token No | SM/25-26/6073 27/10/2026 | Serial | 002 |
| Patient Name | Mr. SATYAMAN BARIK | Contact No | |
| Address | 9 NO LINE, INDIA JUTE MILL | Age | 38 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||