Ticket for Outdoor Patient
| Ward No. 16 | U-PHC No. | Registration No. 01644 | Date 12/02/2019 |
| Token No | SM/18-19/2433 13/02/2019 | Serial | 003 |
| Patient Name | Miss TIYASHA MAJUMDAR | Contact No | NOT GIVEN |
| Address | 16/I SATISH CHANDRA GHOSH LANE | Age | 27 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||