Ticket for Outdoor Patient
| Ward No. 27 | U-PHC No. | Registration No. 01206 | Date 17/03/2020 |
| Token No | SM/25-26/9628 29/10/2025 | Serial | 021 |
| Patient Name | Mrs. SHANKARI SAMANTA | Contact No | 9088555534 |
| Address | 34/B/45 B B GHOSH ROAD PRABASHNAGAR 712203 | Age | 66 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||