Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 04384 | Date 13/05/2021 |
| Token No | SM/25-26/831 14/06/2025 | Serial | 005 |
| Patient Name | Mrs. MENOKA DAS | Contact No | 9874423484 |
| Address | 22 THAKUR BATI STREET | Age | 72 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||