Ticket for Outdoor Patient
| Ward No. 27 | U-PHC No. | Registration No. 03528 | Date 29/12/2022 |
| Token No | SM/25-26/11243 29/11/2025 | Serial | 083 |
| Patient Name | Mr. JAY RABIDAS | Contact No | 9007758885 |
| Address | 65/A/11 GURU GARDEN ROAD PRABASHNAGAR SERAMPORE 712249 | Age | 9 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||