Ticket for Outdoor Patient
| Ward No. 20 | U-PHC No. | Registration No. 13779 | Date 26/11/2025 |
| Token No | SM/25-26/2763 26/11/2025 | Serial | 003 |
| Patient Name | Mrs. NIRUPAMA MONDAL | Contact No | 9830150248 |
| Address | 8/A/3 B.L.C. MILLS BYE LANE | Age | 38 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||