Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 05157 | Date 20/05/2019 |
| Token No | SM/25-26/8841 17/12/2025 | Serial | 003 Last Visit: 17/12/2025 |
| Patient Name | Mr. TAPAN DAS | Contact No | 9674416198 |
| Address | 73/3 NEW G.T ROAD BAIDYABATI (M) | Age | 52 Years,11 Months,15 Days Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||