Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 05205 | Date 23/05/2019 |
| Token No | SM/19-20/3260 23/05/2019 | Serial | 008 Last Visit: 23/05/2019 |
| Patient Name | Mrs. RINA KOYAL | Contact No | 9594598364 |
| Address | 13/B CHATRA CHOWDHURY PARA LANE | Age | 45 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||