Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02718 | Date 05/08/2019 |
| Token No | SM/18-19/6394 12/09/2019 | Serial | 041 |
| Patient Name | Mr. LALTU PAL | Contact No | 6291355343 |
| Address | 86 DEY STREET | Age | 45 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||