Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04930 | Date 27/09/2021 |
| Token No | SM/21-22/2268 24/02/2022 | Serial | 016 |
| Patient Name | Mrs. ASHIMA DAS | Contact No | NOT GIVEN |
| Address | 108/I/2 PATUA PARA | Age | 61 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||