Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01714 | Date 27/10/2018 |
| Token No | SM/18-19/8861 18/02/2019 | Serial | 034 Last Visit: 18/02/2019 |
| Patient Name | Mrs. CHANDRANI PAUL | Contact No | 6291591979 |
| Address | 269 D/A NOBOGRAM GHOSALPARA | Age | 38 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||