Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 03756 | Date 22/01/2020 |
| Token No | SM/19-20/8505 28/01/2020 | Serial | 005 |
| Patient Name | Mrs. SUSMITA GHOSH | Contact No | 8420927734 |
| Address | BHAGIRATHI LANE | Age | 21 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||