Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 13145 | Date 23/06/2025 |
| Token No | SM/25-26/931 23/06/2025 | Serial | 003 |
| Patient Name | Mrs. PUSPA SWAIN | Contact No | 9831132602 |
| Address | 12 PITAMBAR DEY LANE | Age | 54 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||