Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01908 | Date 09/04/2019 |
| Token No | SM/18-19/3201 11/04/2019 | Serial | 023 |
| Patient Name | Mrs. MADHABI PRADHAN | Contact No | NOT GIVEN |
| Address | 45 N L BHATTACHARYA STREET | Age | 25 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||