Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01919 | Date 12/04/2019 |
| Token No | SM/18-19/5605 13/08/2019 | Serial | 030 |
| Patient Name | Mrs. CHAMPA DEVI | Contact No | NOT GIVEN |
| Address | 22/1 N L BHATTACHARJEE STREET | Age | 59 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||