Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01886 | Date 05/04/2019 |
| Token No | SM/18-19/5977 27/08/2019 | Serial | 057 |
| Patient Name | Mrs. LILY DEY | Contact No | 9836094662 |
| Address | 26 A K.C LANE | Age | 52 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||