Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 03687 | Date 06/01/2020 |
| Token No | SM/19-20/8271 07/01/2020 | Serial | 002 |
| Patient Name | Mrs. LALMONI RAJBHOR | Contact No | NOT GIVEN |
| Address | TIN BAZAR | Age | 70 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||