Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02702 | Date 02/08/2019 |
| Token No | SM/19-20/8871 14/09/2020 | Serial | 004 |
| Patient Name | Mrs. MANJU DEVI | Contact No | 7003344019 |
| Address | 53 NO DEY STREET | Age | 48 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||