Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02176 | Date 04/06/2019 |
| Token No | SM/18-19/4000 06/06/2019 | Serial | 025 |
| Patient Name | Mrs. SABILA BEGUM | Contact No | NOT GIVEN |
| Address | 22 K.C BHATTACHARYA LANE | Age | 69 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||