Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03619 | Date 16/12/2019 |
| Token No | SM/19-20/8116 18/12/2019 | Serial | 001 |
| Patient Name | Mrs. RABI CHANDRA | Contact No | NOT GIVEN |
| Address | INDIA JUTE MILL | Age | 61 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||