Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 05135 | Date 07/12/2021 |
| Token No | SM/21-22/1589 09/12/2021 | Serial | 003 |
| Patient Name | Mr. KUMAR KANTA DEY | Contact No | 7890824909 |
| Address | 4 DEY STREET | Age | 80 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||