Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03373 | Date 14/11/2019 |
| Token No | SM/19-20/9017 19/10/2020 | Serial | 002 |
| Patient Name | Mrs. SUMITRA DEVI | Contact No | NOT GIVEN |
| Address | K.M.BHATTACHARYA ST | Age | 58 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||