Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03746 | Date 17/01/2020 |
| Token No | SM/19-20/8439 20/01/2020 | Serial | 003 |
| Patient Name | Mrs. DAYABATI DEBI | Contact No | NOT GIVEN |
| Address | PAL BAGAN, DEY STREET | Age | 62 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||