Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 13860 | Date 12/12/2025 |
| Token No | SM/25-26/2977 12/12/2025 | Serial | 003 |
| Patient Name | Mr. SYAM SUNDAR CHAKRABORTI | Contact No | 6289266284 |
| Address | 24/G/9 FRINGI DANGA ROAD | Age | 60 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||