Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00602 | Date 16/08/2018 |
| Token No | SM/18-19/3659 15/05/2019 | Serial | 011 |
| Patient Name | Mrs. KAMALA DEY | Contact No | |
| Address | DEY STREET | Age | 45 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||