Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02582 | Date 23/07/2019 |
| Token No | SM/18-19/5872 24/08/2019 | Serial | 013 |
| Patient Name | Mr. ROHIT KUMAR | Contact No | NOT GIVEN |
| Address | DEY STREET | Age | 5 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||