Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03098 | Date 23/09/2019 |
| Token No | SM/18-19/6738 27/09/2019 | Serial | 012 |
| Patient Name | Mr. SUSHIL KUMAR KOIRI | Contact No | 7278869737 |
| Address | 79 DEY STREET | Age | 46 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||