Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03513 | Date 29/11/2019 |
| Token No | SM/19-20/7779 29/11/2019 | Serial | 042 |
| Patient Name | Mrs. JAYANTI DE | Contact No | |
| Address | Age | 68 Female | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||