Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00315 | Date 28/08/2018 |
| Token No | SM/18-19/5540 08/08/2019 | Serial | 027 |
| Patient Name | Mrs. KUSUM RAJBHAR | Contact No | NOT GIVEN |
| Address | DEY GHAT LANE | Age | 60 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||