Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 15001 | Date 28/10/2026 |
| Token No | SM/25-26/6107 28/10/2026 | Serial | 027 |
| Patient Name | Mr. GOUTAM SARKAR | Contact No | 9903734335 |
| Address | 73/A R.B. SARANI | Age | 50 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||