Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 02062 | Date 16/05/2019 |
| Token No | SM/18-19/3726 17/05/2019 | Serial | 030 |
| Patient Name | Mrs. NITU DAS | Contact No | 9830706830 |
| Address | 120 POTUA PARA LANE | Age | 39 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||