Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01524 | Date 27/12/2018 |
| Token No | SM/18-19/4396 24/06/2019 | Serial | 026 |
| Patient Name | Mr. BIRESWAR DEY | Contact No | 9051607042 |
| Address | 4 DEY STREET | Age | 68 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||