Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00401 | Date 19/11/2019 |
| Token No | SM/25-26/11748 10/12/2025 | Serial | 007 |
| Patient Name | Mr. SK SAHIFUL | Contact No | 9748824036 |
| Address | 32 MIAJAN DARJEE LANE MALLICKPARA SERAMPORE 712203 | Age | 26 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||