Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01675 | Date 15/02/2019 |
| Token No | SM/18-19/2498 16/02/2019 | Serial | 002 |
| Patient Name | Mr. NARAYAN BARIK | Contact No | 8584948804 |
| Address | 44/1/C DR. N.L. BHATTACHARYA ST | Age | 50 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||