Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04141 | Date 05/03/2021 |
| Token No | SM/20-21/9130 05/03/2021 | Serial | 011 |
| Patient Name | Mrs. SOMA DAS | Contact No | |
| Address | DHULIPARA LANE | Age | 27 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||