Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03575 | Date 09/12/2019 |
| Token No | SM/19-20/8055 14/12/2019 | Serial | 010 |
| Patient Name | Mrs. SANGITA BHAR | Contact No | 9339120084 |
| Address | 47K/3 KUMIR JALA ROAD | Age | 29 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||