Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 02911 | Date 27/08/2019 |
| Token No | SM/21-22/1655 15/12/2021 | Serial | 016 |
| Patient Name | Mrs. MAYA DAS | Contact No | NOT GIVEN |
| Address | AKHRA BATI LANE | Age | 43 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||