Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 05154 | Date 14/12/2021 |
| Token No | SM/21-22/1650 15/12/2021 | Serial | 011 |
| Patient Name | Mrs. PARUL DAS | Contact No | NOT GIVEN |
| Address | 32 DOSTI LANE | Age | 45 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||