Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 09139 | Date 21/04/2025 |
| Token No | SM/25-26/957 21/04/2025 | Serial | 052 |
| Patient Name | Mr. PRINCE DAS | Contact No | 7890720347 |
| Address | SARDAR PARA DAKSHIN RAJYADHARPUR MALLICKPARA 712203 | Age | 14 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||