Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04614 | Date 15/07/2021 |
| Token No | SM/22-23/6894 08/12/2022 | Serial | 023 |
| Patient Name | Mrs. MALATI DAS | Contact No | |
| Address | Age | 65 Y Female | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||