Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 12939 | Date 30/04/2025 |
| Token No | SM/25-26/628 02/06/2025 | Serial | 004 |
| Patient Name | Mrs. PUTUL SHAW | Contact No | 7439028344 |
| Address | 12/A/1 RAM SITA LANE | Age | 24 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||