Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 06670 | Date 30/04/2024 |
| Token No | SM/25-26/9678 30/10/2025 | Serial | 035 |
| Patient Name | Mrs. MOMTAJ BIBI | Contact No | 8961248491 |
| Address | 23/A MIYAJAN DARJI LANE MALLICKPARA SERAMPORE 712203 | Age | 43 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | 120/70 mmHg | Weight | 51 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||