Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04352 | Date 04/05/2021 |
| Token No | SM/25-26/5616 28/08/2026 | Serial | 006 |
| Patient Name | Mr. DEBNATH DEY | Contact No | 9836518176 |
| Address | 8 GOALA PARA LANE | Age | 47 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||