Ticket for Outdoor Patient
| Ward No. 28 | U-PHC No. | Registration No. 10350 | Date 31/12/2025 |
| Token No | SM/25-26/12604 31/12/2025 | Serial | 051 |
| Patient Name | Miss SANVI NAG | Contact No | 7890094528 |
| Address | 30/66 TARAPUKUR COLONY SERAMPORE 712203 | Age | 8 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||