Ticket for Outdoor Patient
| Ward No. 18 | U-PHC No. | Registration No. 01578 | Date 17/01/2019 |
| Token No | SM/18-19/3456 29/04/2019 | Serial | 030 |
| Patient Name | Mrs. SIKHA DAS | Contact No | NOT GIVEN |
| Address | 150 N N COLONY | Age | 56 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||