Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02795 | Date 13/08/2019 |
| Token No | SM/18-19/5675 16/08/2019 | Serial | 043 |
| Patient Name | Mrs. NILU ADHIKARY | Contact No | 8100631337 |
| Address | 86 DEY STREET | Age | 22 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||