Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01609 | Date 01/02/2019 |
| Token No | SM/25-26/3017 17/12/2025 | Serial | 005 |
| Patient Name | Mrs. SULEKHA CHATTERJEE | Contact No | 9007294567 |
| Address | 10 A.B. GARDEN LANE | Age | 77 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||