Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04204 | Date 30/03/2021 |
| Token No | SM/22-23/9004 21/04/2023 | Serial | 024 |
| Patient Name | Mr. DEBKUMAR RAJBHAR | Contact No | NOT GIVEN |
| Address | 79 DEY STREET | Age | 50 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||