Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00260 | Date 24/08/2018 |
| Token No | SM/18-19/3691 16/05/2019 | Serial | 031 |
| Patient Name | Mrs. ALOKA DEY | Contact No | NOT GIVEN |
| Address | 90/C/6 DEY STREET | Age | 63 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||