Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 13112 | Date 12/06/2025 |
| Token No | SM/25-26/806 12/06/2025 | Serial | 031 |
| Patient Name | Mr. RINA SHAW | Contact No | 9748232143 |
| Address | 52A/2 PANCHANAN TALA LANE | Age | 38 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||