Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00194 | Date 17/08/2018 |
| Token No | SM/18-19/2985 30/03/2019 | Serial | 003 |
| Patient Name | Mrs. SUSMITA SARKAR | Contact No | 8017789968 |
| Address | 3/2 K.C MUKHERJEE STREET | Age | 42 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||