Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 11533 | Date 14/05/2024 |
| Token No | SM/25-26/393 07/05/2025 | Serial | 015 |
| Patient Name | Mr. MD SAMSAD | Contact No | 9123331886 |
| Address | 21 DR. N L BHATTACHARJEE STREET | Age | 32 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||