Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02851 | Date 20/08/2019 |
| Token No | SM/18-19/6095 30/08/2019 | Serial | 078 |
| Patient Name | Mrs. SHIBANI JHA | Contact No | 8581073230 |
| Address | CHATRA, COMPANY PUKUR | Age | 18 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||