Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 04210 | Date 30/03/2021 |
| Token No | SM/22-23/2674 07/04/2022 | Serial | 003 |
| Patient Name | Miss SUSMITA BAG | Contact No | 9073333859 |
| Address | 3 A B GARDEN LANE | Age | 11 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||