Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 03547 | Date 05/12/2019 |
| Token No | SM/19-20/7955 09/12/2019 | Serial | 028 |
| Patient Name | Mrs. SULATA PURAKAIT | Contact No | 9674346637 |
| Address | 11/B J N LAHIRI ROAD | Age | 54 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||