Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02626 | Date 26/07/2019 |
| Token No | SM/18-19/6393 12/09/2019 | Serial | 040 |
| Patient Name | Mr. SK SARIF | Contact No | 9123626412 |
| Address | 9 K C BHATTACHARJEE STREET | Age | 49 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||