Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01995 | Date 29/04/2019 |
| Token No | SM/18-19/3489 30/04/2019 | Serial | 030 |
| Patient Name | Baby SONAM RAM | Contact No | NOT GIVEN |
| Address | 7 DEY GHAT LANE | Age | 7 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||