Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01755 | Date 07/03/2019 |
| Token No | SM/18-19/3229 12/04/2019 | Serial | 022 |
| Patient Name | Mrs. SHYAMALI ROY | Contact No | 9679480054 |
| Address | 13 KAILASH CHATTERJEE LANE | Age | 46 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||