Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 14818 | Date 29/08/2026 |
| Token No | SM/25-26/5621 29/08/2026 | Serial | 005 |
| Patient Name | Mrs. SONALI DUTTA GUPTA | Contact No | 9681052908 |
| Address | 57/12 RAYLAND ROAD | Age | 50 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||