Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 09591 | Date 19/07/2025 |
| Token No | SM/25-26/6143 11/08/2025 | Serial | 008 |
| Patient Name | Mrs. BANANI KARMAKAR ADAK | Contact No | 9088775427 |
| Address | 5/A/2 BARO BAGAN LANE SERAMPORE 712203 | Age | 41 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||