Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 07040 | Date 19/06/2024 |
| Token No | SM/25-26/3817 21/06/2025 | Serial | 023 |
| Patient Name | Mr. MOHAMMAD SURAJ | Contact No | 8274883845 |
| Address | 26/A MIYAZAN DARJI LANE MALLICKPARA SERAMPORE 712203 | Age | 12 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||