Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00410 | Date 19/11/2019 |
| Token No | SM/25-26/9544 25/10/2025 | Serial | 010 |
| Patient Name | Mrs. SAHIBA BEGAM | Contact No | 6290644548 |
| Address | 13/A MIAJAAN DARJI LANE MALLICKPARA SERAMPORE 712203 | Age | 25 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||