Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00134 | Date 16/09/2019 |
| Token No | SM/19-20/1599 16/01/2020 | Serial | 003 |
| Patient Name | Mr. RAM CHANDRA KOLEY | Contact No | 9062304792 |
| Address | GHORAMARA PURBAPARA RAJYADHARPUR 712203 | Age | 99 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||