Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02063 | Date 16/05/2019 |
| Token No | SM/18-19/3727 17/05/2019 | Serial | 031 |
| Patient Name | Mr. SAYAN DEY | Contact No | 9432067979 |
| Address | 7 DEY ST | Age | 9 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||