Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02013 | Date 02/05/2019 |
| Token No | SM/18-19/3942 03/06/2019 | Serial | 031 |
| Patient Name | Mrs. KABITA SHRIMANI | Contact No | NOT GIVEN |
| Address | 6 BECHU DEY LANE | Age | 40 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||