Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01780 | Date 10/03/2019 |
| Token No | SM/18-19/2850 13/03/2019 | Serial | 040 |
| Patient Name | Mrs. DOLI BEGUM | Contact No | 7890565382 |
| Address | K C BHATTACHARYA STREET | Age | 52 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||