Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 05404 | Date 09/02/2022 |
| Token No | SM/21-22/2215 21/02/2022 | Serial | 019 |
| Patient Name | Miss DALIA NANDAN | Contact No | 8420518294 |
| Address | 7/5 POTUA PARA LANE | Age | 27 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||