Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04938 | Date 27/09/2021 |
| Token No | SM/21-22/1875 11/01/2022 | Serial | 022 |
| Patient Name | Mr. BASKIT DAS | Contact No | NOT GIVEN |
| Address | 120 POTUA PARA | Age | 76 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||