Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05180 | Date 22/12/2021 |
| Token No | SM/21-22/1726 23/12/2021 | Serial | 005 |
| Patient Name | Mr. SUSHANTA BISWAL | Contact No | 9032934651 |
| Address | 44 DR. NANILAL BHATTACHARJEE STREET | Age | 50 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||