Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 10203 | Date 21/11/2025 |
| Token No | SM/25-26/10775 21/11/2025 | Serial | 021 |
| Patient Name | Mr. SUBASH CHANDRA PAL | Contact No | 9230213046 |
| Address | 22/B/2/B ANISHMOHAN ROYCHOWDHURY SARANI MALLICKPARA SERAMPORE 712203 | Age | 64 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||