Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02335 | Date 21/06/2019 |
| Token No | SM/18-19/4464 25/06/2019 | Serial | 052 |
| Patient Name | Miss SABANA KHATUN | Contact No | 6290635774 |
| Address | 21 A K C BHATTACHARYA STREET | Age | 20 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||