Ticket for Outdoor Patient
| Ward No. 27 | U-PHC No. | Registration No. 01216 | Date 17/03/2020 |
| Token No | SM/25-26/6118 09/08/2025 | Serial | 018 |
| Patient Name | Mr. SAYAN ADAK | Contact No | 9874341751 |
| Address | 65/25/10/E MAHESH JANNAGAR ROAD PRABASHNAGAR 712249 | Age | 12 YRS Male |
| Token For | Visit Doctor,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||