Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03048 | Date 16/09/2019 |
| Token No | SM/18-19/6534 17/09/2019 | Serial | 034 |
| Patient Name | Miss RENUKA RAJBHAR | Contact No | 9007591910 |
| Address | 79 DEY STREET | Age | 22 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||