Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 03651 | Date 31/12/2019 |
| Token No | SM/19-20/8235 06/01/2020 | Serial | 004 |
| Patient Name | Mr. SONTU DAS | Contact No | 9433616121 |
| Address | 53/D THAKUR BATI STREET | Age | 40 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||