Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03741 | Date 14/01/2020 |
| Token No | SM/19-20/8408 16/01/2020 | Serial | 011 |
| Patient Name | Miss RUPA PASI | Contact No | 9883071314 |
| Address | 18 K M BHATTACHARJEES SREET | Age | 26 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||