Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03596 | Date 10/12/2019 |
| Token No | SM/19-20/7999 10/12/2019 | Serial | 018 |
| Patient Name | Mr. BRISHIKESHAM MALLICK | Contact No | 8334073862 |
| Address | 12 PITAMBAR DEY LANE | Age | 11 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 30 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||