Ticket for Outdoor Patient
| Ward No. 9 | U-PHC No. | Registration No. 06147 | Date 20/06/2022 |
| Token No | SM/22-23/5071 12/09/2022 | Serial | 018 |
| Patient Name | Mr. MOHON SHAW | Contact No | NOT GIVEN |
| Address | TIN BAZAR BYE LANE | Age | 72 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||