Ticket for Outdoor Patient
| Ward No. 9 | U-PHC No. | Registration No. 02801 | Date 13/08/2019 |
| Token No | SM/18-19/6622 23/09/2019 | Serial | 024 |
| Patient Name | Mrs. POILA BAG | Contact No | NOT GIVEN |
| Address | BELTING BAZAR | Age | 60 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||