Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02514 | Date 19/07/2019 |
| Token No | SM/18-19/5135 26/07/2019 | Serial | 014 |
| Patient Name | Mrs. RABITA DEBI | Contact No | NOT GIVEN |
| Address | DEY ST | Age | 30 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||