Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 13163 | Date 25/06/2025 |
| Token No | SM/25-26/977 25/06/2025 | Serial | 031 |
| Patient Name | Mrs. PUNAM KOIRI. | Contact No | 8646862171 |
| Address | 51 POTUA PARA | Age | 51 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||