Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03184 | Date 15/10/2019 |
| Token No | SM/18-19/7486 18/11/2019 | Serial | 028 |
| Patient Name | Mrs. PARBATI DEY | Contact No | 8013303753 |
| Address | 7 NO DEY STREET | Age | 72 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||