Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 00662 | Date 11/09/2018 |
| Token No | SM/18-19/4202 14/06/2019 | Serial | 060 |
| Patient Name | Mrs. INDIRA ROY | Contact No | NOT GIVEN |
| Address | CHATRA BOUBAZAR | Age | 57 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||