Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 01706 | Date 22/02/2019 |
| Token No | SM/18-19/2980 29/03/2019 | Serial | 028 |
| Patient Name | Mrs. SUSANTA KAR | Contact No | 9054537534 |
| Address | 118 G.T. ROAD, MANIKATALA | Age | 42 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||