Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01702 | Date 27/10/2018 |
| Token No | SM/18-19/3204 31/10/2018 | Serial | 008 Last Visit: 25/01/2019 |
| Patient Name | Mrs. SUKLA HALDER | Contact No | |
| Address | CHATRA BAGER BAGAN | Age | 33 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||