Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 03400 | Date 15/11/2019 |
| Token No | SM/19-20/7897 06/12/2019 | Serial | 011 |
| Patient Name | Mrs. MANGALA MONDAL | Contact No | NOT GIVEN |
| Address | SASHI BHUSAN GHOSH LANE | Age | 46 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||