Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 09598 | Date 21/07/2025 |
| Token No | SM/25-26/5071 21/07/2025 | Serial | 054 |
| Patient Name | Mr. SURAJ KUMAR SHAW | Contact No | 7439433919 |
| Address | GHORAMARA PURBAPARA MALLICKPARA 712203 | Age | 14 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||