Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03817 | Date 17/02/2020 |
| Token No | SM/20-21/9163 17/03/2021 | Serial | 009 |
| Patient Name | Mr. AMIT KUMAR SHAW | Contact No | |
| Address | 2 LALIT MOHAN BHATTACHARJEE STREET | Age | 42 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||