Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02950 | Date 30/08/2019 |
| Token No | SM/18-19/6169 03/09/2019 | Serial | 016 |
| Patient Name | Mrs. MANJU DAS | Contact No | 8100592005 |
| Address | CHATRA PAMPA NAGAR | Age | 45 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||