Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01945 | Date 22/04/2019 |
| Token No | SM/18-19/3360 23/04/2019 | Serial | 031 |
| Patient Name | Mrs. DAMAYANTI BARAT | Contact No | NOT GIVEN |
| Address | 40 N L BHATTACHARJEE STREET | Age | 61 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||