Ticket for Outdoor Patient
| Ward No. 21 | U-PHC No. | Registration No. 03009 | Date 06/09/2019 |
| Token No | SM/18-19/6333 11/09/2019 | Serial | 003 |
| Patient Name | Mrs. SANDHYA ADHIKARI | Contact No | NOT GIVEN |
| Address | KALITALA | Age | 50 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||