Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01613 | Date 01/02/2019 |
| Token No | SM/18-19/5067 23/07/2019 | Serial | 034 |
| Patient Name | Mrs. PARBATI BISWAL | Contact No | NOT GIVEN |
| Address | NEAR SEARAMPORE COLLEGE | Age | 45 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||