Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 09712 | Date 12/06/2021 |
| Token No | SM/21-22/2190 12/06/2021 | Serial | 012 Last Visit: 12/06/2021 |
| Patient Name | Mrs. SAMA PODDAR DAS | Contact No | |
| Address | 5 NO COLONY SERAMPORE | Age | 33 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||