Ticket for Outdoor Patient
| Ward No. 25 | U-PHC No. | Registration No. 03740 | Date 14/01/2020 |
| Token No | SM/19-20/8440 20/01/2020 | Serial | 004 |
| Patient Name | Mr. BALARAM DAS | Contact No | 8420925822 |
| Address | 3/21 MAHESH COLONY | Age | 37 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||