Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 10304 | Date 16/12/2025 |
| Token No | SM/25-26/12029 16/12/2025 | Serial | 029 |
| Patient Name | Mr. AFJAL KHAN | Contact No | 9264282367 |
| Address | 13 MIYAJAN DARJEE LANE MALLICKPARA SERAMPORE 712249 | Age | 7 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||