Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 12361 | Date 20/11/2024 |
| Token No | SM/25-26/6078 27/10/2026 | Serial | 007 |
| Patient Name | Miss PUSHPITA PAKIRA | Contact No | 8442811059 |
| Address | 13 A B GARDEN LANE | Age | 12 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||