Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 10085 | Date 21/10/2025 |
| Token No | SM/25-26/9403 21/10/2025 | Serial | 012 |
| Patient Name | Mrs. SABNAM KHATOON | Contact No | 8100120149 |
| Address | 18/A MIYAJAN DARJI LANE MALLICKPARA SERAMPORE 712203 | Age | 21 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||