Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02408 | Date 05/07/2019 |
| Token No | SM/18-19/5484 06/08/2019 | Serial | 063 |
| Patient Name | Mr. PINTU DAS | Contact No | 7595810567 |
| Address | 5/2A DEY STREET | Age | 44 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||