Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 09223 | Date 28/01/2021 |
| Token No | SM/20-21/29853 28/01/2021 | Serial | 032 Last Visit: 28/01/2021 |
| Patient Name | Mrs. GULABI DEBI | Contact No | |
| Address | DEY GHAT LANE | Age | 55 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||