Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01370 | Date 14/12/2018 |
| Token No | SM/18-19/3457 29/04/2019 | Serial | 031 |
| Patient Name | Mrs. G. ANITA | Contact No | 9903531379 |
| Address | N.L BHATTACHARYA ST | Age | 30 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||