Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01694 | Date 26/10/2018 |
| Token No | SM/19-20/7765 01/08/2019 | Serial | 096 Last Visit: 01/08/2019 |
| Patient Name | Miss PIYALI ROUTH | Contact No | 7679009490 |
| Address | SANTOSHPUR | Age | 23 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||