Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02161 | Date 03/06/2019 |
| Token No | SM/18-19/3974 04/06/2019 | Serial | 029 |
| Patient Name | Mrs. REBA DEY | Contact No | 9432083394 |
| Address | 4A DEY STREET | Age | 68 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||