Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02289 | Date 17/06/2019 |
| Token No | SM/18-19/4293 18/06/2019 | Serial | 012 |
| Patient Name | Mrs. NIVA DEVI | Contact No | NOT GIVEN |
| Address | DEY ST | Age | 43 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||