Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01617 | Date 05/02/2019 |
| Token No | SM/18-19/5862 24/08/2019 | Serial | 003 |
| Patient Name | Mr. RANJIT SARKAR | Contact No | NOT GIVEN |
| Address | 11 RAM SITA LANE | Age | 77 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||