Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01673 | Date 15/02/2019 |
| Token No | SM/18-19/3849 28/05/2019 | Serial | 023 |
| Patient Name | Mr. SUKUMAR DAS | Contact No | 9163101741 |
| Address | 27 DEY STREET | Age | 82 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||