Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02597 | Date 24/07/2019 |
| Token No | SM/25-26/1993 10/09/2025 | Serial | 020 |
| Patient Name | Mrs. KRISHNA DEY | Contact No | 9051232331 |
| Address | 5/2C DEY STREET | Age | 65 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||