Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 14997 | Date 28/10/2026 |
| Token No | SM/25-26/6102 28/10/2026 | Serial | 022 |
| Patient Name | Miss AISHANI DAS | Contact No | 9874559102 |
| Address | 79 R.B. SARANI | Age | 6 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||