Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01768 | Date 08/03/2019 |
| Token No | SM/18-19/2757 09/03/2019 | Serial | 006 |
| Patient Name | Mrs. MIRA DUTTA | Contact No | NOT GIVEN |
| Address | 47 KALITALA | Age | 65 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||