Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 10000 | Date 24/09/2025 |
| Token No | SM/25-26/8414 24/09/2025 | Serial | 005 |
| Patient Name | Mrs. SHARMILA MALLICK | Contact No | 9330375336 |
| Address | 29/A MIYAJAN DARJI LANE MALLICKPARA SERAMPORE 712203 | Age | 28 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||