Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 02250 | Date 13/06/2019 |
| Token No | SM/18-19/4206 14/06/2019 | Serial | 064 |
| Patient Name | Mrs. SUNITA DAS | Contact No | NOT GIVEN |
| Address | 22 BOSE PARA | Age | 47 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||