Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00150 | Date 08/08/2018 |
| Token No | SM/18-19/2667 02/03/2019 | Serial | 001 |
| Patient Name | Mr. GANESH BISWAL | Contact No | NOT GIVEN |
| Address | CHOWDHURY PARA, MANNA BARI | Age | 72 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||