Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00032 | Date 03/08/2018 |
| Token No | SM/18-19/3111 05/04/2019 | Serial | 025 |
| Patient Name | Mrs. ANJU PRADHAN | Contact No | 8961448657 |
| Address | 45 DR N L BHATTACHARYA STREET | Age | 47 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||