Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 09129 | Date 21/04/2025 |
| Token No | SM/25-26/909 21/04/2025 | Serial | 004 |
| Patient Name | Mrs. SEKH SULTANA | Contact No | 9903257528 |
| Address | 36/O MIYAJAN DARJEE LANE MALLICKPARA SERAMPORE 712203 | Age | 25 YRS Female |
| Token For | Visit Doctor,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||