Ticket for Outdoor Patient
| Ward No. 28 | U-PHC No. | Registration No. 02553 | Date 17/12/2018 |
| Token No | SM/18-19/5492 20/12/2018 | Serial | 005 Last Visit: 08/02/2019 |
| Patient Name | Mrs. KALPANA MAITY | Contact No | |
| Address | TARAPUKUR GOV. QUTAER | Age | 62 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||