Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01819 | Date 20/03/2019 |
| Token No | SM/18-19/2913 20/03/2019 | Serial | 009 |
| Patient Name | Master ASUTOSH KOIRI | Contact No | |
| Address | Age | 11 Male | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||