Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 15004 | Date 28/10/2026 |
| Token No | SM/25-26/6110 28/10/2026 | Serial | 030 |
| Patient Name | Mr. DEBKUMAR GHATAK | Contact No | 9732028472 |
| Address | 630 G.T. ROAD | Age | 42 yrs Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||