Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02072 | Date 16/05/2019 |
| Token No | SM/18-19/3724 17/05/2019 | Serial | 028 |
| Patient Name | Mrs. RIYA SHAW | Contact No | NOT GIVEN |
| Address | 11M P.K. DAS LANE | Age | 32 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||