Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04565 | Date 06/07/2021 |
| Token No | SM/21-22/552 06/07/2021 | Serial | 006 |
| Patient Name | Mrs. DIPALI BOSE | Contact No | |
| Address | Age | 40 Female | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||