Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00770 | Date 21/01/2020 |
| Token No | SM/19-20/1753 22/01/2020 | Serial | 033 |
| Patient Name | Mr. SHAHADUT MALLICK | Contact No | 6290382251 |
| Address | 33 MIYAJAN DARJEE LANE SERAMPORE 712203 | Age | 38 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||