Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00121 | Date 07/08/2018 |
| Token No | SM/21-22/1542 29/11/2021 | Serial | 017 |
| Patient Name | Mrs. SHAMPA DEY | Contact No | |
| Address | 5B/5 DEY STREET | Age | 57 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||