Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03213 | Date 18/10/2019 |
| Token No | SM/18-19/6979 18/10/2019 | Serial | 004 |
| Patient Name | Mrs. AYESHA MALLICK | Contact No | 9830753312 |
| Address | 49 NANILAL BHATTACHARYA STREET | Age | 36 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||