Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13129 | Date 17/06/2025 |
| Token No | SM/25-26/865 17/06/2025 | Serial | 003 |
| Patient Name | Miss KHUSHI BISWAL | Contact No | 8910322459 |
| Address | N.L. BHATTACHARYA STREET | Age | 14 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||