Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 05301 | Date 13/01/2022 |
| Token No | SM/21-22/1918 17/01/2022 | Serial | 016 |
| Patient Name | Mr. TARAKESWAR NATH GIRI | Contact No | 8013111755 |
| Address | 79A DEY STREET | Age | 55 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||