Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03903 | Date 12/03/2020 |
| Token No | SM/20-21/9129 05/03/2021 | Serial | 010 |
| Patient Name | Mrs. MANJU DEBI | Contact No | NOT GIVEN |
| Address | INDIA JUTE MILL | Age | 43 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||