Ticket for Outdoor Patient
| Ward No. 16 | U-PHC No. | Registration No. 03230 | Date 18/10/2019 |
| Token No | SM/19-20/8993 12/10/2020 | Serial | 005 |
| Patient Name | Mr. KAILASH DAS | Contact No | 9804890802 |
| Address | 124/1 MANIKTALA | Age | 35 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||