Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01861 | Date 04/04/2019 |
| Token No | SM/18-19/3657 15/05/2019 | Serial | 009 |
| Patient Name | Mr. GOUTAM BANERJEE | Contact No | 9681059721 |
| Address | 35 RISHI BANKIM SARANI | Age | 58 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||