Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 10111 | Date 30/10/2025 |
| Token No | SM/25-26/9645 30/10/2025 | Serial | 002 |
| Patient Name | Mrs. KALPANA CHAKRABORTY | Contact No | 8013356121 |
| Address | PANDIT SATGHARA MALLICKPARA 712203 | Age | 66 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||