Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03618 | Date 16/12/2019 |
| Token No | SM/19-20/8117 18/12/2019 | Serial | 002 |
| Patient Name | Mrs. MITA DEY | Contact No | NOT GIVEN |
| Address | 53 PANCHANAN TALA LANE | Age | 43 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||