Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00170 | Date 18/08/2018 |
| Token No | SM/18-19/6532 17/09/2019 | Serial | 032 |
| Patient Name | Mrs. DUKKHI BISWAL | Contact No | 7003521703 |
| Address | 10,DEY GHAT LANE | Age | 60 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||