Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 05138 | Date 08/12/2021 |
| Token No | SM/21-22/1588 09/12/2021 | Serial | 002 |
| Patient Name | Mrs. RATNA DEY | Contact No | 7685886431 |
| Address | 42A/1 KHAS BAGAN LANE | Age | 23 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||