Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03383 | Date 15/11/2019 |
| Token No | SM/18-19/7405 15/11/2019 | Serial | 004 |
| Patient Name | Mr. PRASENJIT SANKHA BANIK | Contact No | 9330937776 |
| Address | 161/1 G T ROAD NIVEDITA PALLY, BAIDYABATI | Age | 40 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||