Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00309 | Date 28/08/2018 |
| Token No | SM/18-19/2754 09/03/2019 | Serial | 003 |
| Patient Name | Mrs. GOURI DEY | Contact No | NOT GIVEN |
| Address | 5 DEY STREET | Age | 64 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||