Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 02656 | Date 30/07/2019 |
| Token No | SM/18-19/5604 13/08/2019 | Serial | 029 |
| Patient Name | Mrs. DIPALI DAS | Contact No | 7596898576 |
| Address | 14 J N LAHIRI ROAD | Age | 50 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||