Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00875 | Date 05/02/2020 |
| Token No | SM/19-20/2031 06/02/2020 | Serial | 004 |
| Patient Name | Mr. SK ROHAN | Contact No | 9007761682 |
| Address | 88/C MIYAJAN DARJI LANE MALLICKPARA SERAMPORE 712203 | Age | 9 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||