Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03382 | Date 15/11/2019 |
| Token No | SM/18-19/7655 22/11/2019 | Serial | 014 |
| Patient Name | Miss OLIVA SANKHA BANIK | Contact No | 9330937776 |
| Address | 161/1 G T ROAD NIVEDITA PALLY, BAIDYABATI | Age | 7 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||