Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02667 | Date 30/07/2019 |
| Token No | SM/19-20/8964 28/09/2020 | Serial | 014 |
| Patient Name | Mrs. KALPANA DAS | Contact No | NOT GIVEN |
| Address | 3 LALIT MOHON BHATTACHARYA STREET | Age | 45 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||