Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03857 | Date 25/02/2020 |
| Token No | SM/19-20/8615 25/02/2020 | Serial | 012 |
| Patient Name | Mr. MADAN MOHON KOLEY | Contact No | 9903862723 |
| Address | PANCHANAN TALA LANE | Age | 67 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||