Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00366 | Date 13/08/2018 |
| Token No | SM/19-20/8777 26/06/2020 | Serial | 021 |
| Patient Name | Mrs. KALAWATI DEVI | Contact No | 7044131086 |
| Address | 9 NO GATE NAYA BAGAN | Age | 65 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||