Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01981 | Date 25/04/2019 |
| Token No | SM/18-19/3404 25/04/2019 | Serial | 036 |
| Patient Name | Miss MOUMITA DAS | Contact No | |
| Address | Age | 24 YRS Female | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||