Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 10059 | Date 15/10/2025 |
| Token No | SM/25-26/9116 15/10/2025 | Serial | 005 |
| Patient Name | Mrs. SULTANA BIBI | Contact No | 8100606877 |
| Address | 29 MIYAZAN DARJI LANE MALLICKPARA SERAMPORE 712203 | Age | 34 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||