Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04192 | Date 24/03/2021 |
| Token No | SM/20-21/9199 24/03/2021 | Serial | 002 |
| Patient Name | Mrs. MINA MAITY | Contact No | NOT GIVEN |
| Address | KHASBAGAN | Age | 46 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||