Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 09670 | Date 30/07/2025 |
| Token No | SM/25-26/5570 30/07/2025 | Serial | 036 |
| Patient Name | Mr. DIPAK NATH | Contact No | 9804575971 |
| Address | 5 NO COLONY DAKSHIN RAJYADHARPUR MALLICKPARA 712203 | Age | 56 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||