Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 01396 | Date 28/09/2018 |
| Token No | SM/18-19/2214 29/09/2018 | Serial | 002 Last Visit: 18/01/2019 |
| Patient Name | Mrs. SANGITA DAS | Contact No | 9874765270 |
| Address | 18D VIVEKANAND LANE | Age | 25 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||