Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 13100 | Date 11/06/2025 |
| Token No | SM/25-26/765 11/06/2025 | Serial | 028 |
| Patient Name | Mrs. BINDE POREL. | Contact No | NOT GIVEN |
| Address | 19 DOSTI LANE | Age | 51 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||