Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04380 | Date 27/06/2023 |
| Token No | SM/25-26/12167 20/12/2025 | Serial | 007 |
| Patient Name | Mrs. PINKI BHARATI DAS | Contact No | 9508801190 |
| Address | GHORAMARA PURBAPARA SERAMORE 712203 | Age | 28 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||