Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02886 | Date 26/08/2019 |
| Token No | SM/18-19/5972 27/08/2019 | Serial | 052 |
| Patient Name | Miss TAPASI BAG | Contact No | NOT GIVEN |
| Address | TELEPHONE EXCHANGE | Age | 25 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||