Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00086 | Date 06/08/2018 |
| Token No | SM/18-19/5761 20/08/2019 | Serial | 029 |
| Patient Name | Mr. MADHUSUDAN DEY | Contact No | |
| Address | Age | 47 Male | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||