Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04340 | Date 28/04/2021 |
| Token No | SM/25-26/1413 28/07/2025 | Serial | 004 |
| Patient Name | Mrs. RUBINA BEGUM | Contact No | 6289810798 |
| Address | 49/A DR. NANILAL BHATTACHARYA STREET | Age | 28 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||