Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02179 | Date 04/06/2019 |
| Token No | SM/18-19/6291 06/09/2019 | Serial | 039 |
| Patient Name | Miss NISHA GIRI | Contact No | 8013111755 |
| Address | 79 DEY STREET | Age | 21 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||