Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 13171 | Date 26/06/2025 |
| Token No | SM/25-26/987 26/06/2025 | Serial | 007 |
| Patient Name | Mrs. USHA DEBI | Contact No | 7847899738 |
| Address | 5A RAJMOHAN GOSWAMI LANE | Age | 48 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||