Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03748 | Date 17/01/2020 |
| Token No | SM/19-20/8447 22/01/2020 | Serial | 001 |
| Patient Name | Mr. SHIBKUMAR SHAW | Contact No | 7450087690 |
| Address | 2 LALIT MOHON BHATTACHARYA STREET | Age | 49 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||