Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04597 | Date 13/07/2021 |
| Token No | SM/21-22/606 13/07/2021 | Serial | 021 |
| Patient Name | Mrs. DIPALIRANI ROY CHOWDHURY | Contact No | |
| Address | Age | 62 Female | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||