Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03648 | Date 27/12/2019 |
| Token No | SM/19-20/8160 27/12/2019 | Serial | 006 |
| Patient Name | Miss CHHANDA GAYEN | Contact No | |
| Address | Age | 17 Female | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||