Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01904 | Date 09/04/2019 |
| Token No | SM/18-19/3326 22/04/2019 | Serial | 019 |
| Patient Name | Mrs. DEWANTI DEBI | Contact No | NOT GIVEN |
| Address | NAYA BAGAN, RAM SITA LANE | Age | 50 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||