Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 10010 | Date 25/09/2025 |
| Token No | SM/25-26/8583 25/09/2025 | Serial | 088 |
| Patient Name | Mrs. ROJINA MALLICK | Contact No | 8478967378 |
| Address | 30 CHILEKHANA ROAD MALLICKPARA SERAMPORE 712203 | Age | 40 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||