Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 01570 | Date 04/07/2020 |
| Token No | SM/19-20/4098 04/07/2020 | Serial | 006 |
| Patient Name | Mrs. KALYANI DAS | Contact No | 9330392625 |
| Address | 31/A MIYAJAN DARJI LANE MALLICKPARA SERAMPORE 712203 | Age | 79 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||