Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 13395 | Date 18/08/2025 |
| Token No | SM/25-26/2354 21/10/2025 | Serial | 007 |
| Patient Name | Mr. SANGITA MAITRA | Contact No | 7439282805 |
| Address | 20 NO PATUA PARA LANE | Age | 20 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||