Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 10167 | Date 13/11/2025 |
| Token No | SM/25-26/10363 13/11/2025 | Serial | 032 |
| Patient Name | Mrs. KALPANA ROY | Contact No | 8420935056 |
| Address | 5 MALLICKPARA BYE LANE MALLICKPARA SERAMPORE 712203 | Age | 50 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||