Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 04110 | Date 02/12/2020 |
| Token No | SM/19-20/9075 02/12/2020 | Serial | 010 |
| Patient Name | Mrs. GITA BHATTACHRYA | Contact No | NOT GIVEN |
| Address | 68 THAKUR BATI STREET | Age | 73 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||