Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 07269 | Date 29/06/2024 |
| Token No | SM/25-26/6101 09/08/2025 | Serial | 001 |
| Patient Name | Mr. SHARUKH KHAN | Contact No | 9830681972 |
| Address | 1 CHELEKHANA ROAD MALLICKPARA 712203 | Age | 29 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||