Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04167 | Date 11/03/2019 |
| Token No | SM/18-19/10374 11/03/2019 | Serial | 083 Last Visit: 11/03/2019 |
| Patient Name | Miss SANGITA BAG | Contact No | 9674026023 |
| Address | 20C BAROBAGAN LANE | Age | 13 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||