Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05149 | Date 14/12/2021 |
| Token No | SM/21-22/1651 15/12/2021 | Serial | 012 |
| Patient Name | Mr. DIPAK BISWAL | Contact No | 6289525210 |
| Address | 45 N L BHATTACHARJEE STREET | Age | 15 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||