Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01343 | Date 06/12/2018 |
| Token No | SM/22-23/6003 03/11/2022 | Serial | 031 |
| Patient Name | Mrs. SONALI DAS | Contact No | 8420160706 |
| Address | 80 DEY ST | Age | 30 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||