Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03604 | Date 12/12/2019 |
| Token No | SM/19-20/8123 18/12/2019 | Serial | 008 |
| Patient Name | Mrs. SIMA DAS | Contact No | 8961755378 |
| Address | 7 DEY GHAT LANE | Age | 35 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||