Ticket for Outdoor Patient
| Ward No. 16 | U-PHC No. | Registration No. 05141 | Date 08/12/2021 |
| Token No | SM/21-22/1596 09/12/2021 | Serial | 010 |
| Patient Name | Mrs. RITA DEY | Contact No | NOT GIVEN |
| Address | 140 G T ROAD, MANIKTALA | Age | 53 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||