Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01241 | Date 20/09/2018 |
| Token No | SM/18-19/1891 22/09/2018 | Serial | 004 Last Visit: 22/09/2018 |
| Patient Name | Mrs. JHUMA MUKHERJEE | Contact No | 7044594944 |
| Address | 33A, PANCHANAN TALA DEY STREET, | Age | 44 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||