Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01653 | Date 13/02/2019 |
| Token No | SM/18-19/2431 13/02/2019 | Serial | 001 |
| Patient Name | Mrs. CHAITALI BANERJEE | Contact No | 9432734743 |
| Address | 5D PITAMBAR DEY LANE | Age | 54 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||