Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03709 | Date 07/01/2020 |
| Token No | SM/19-20/8344 11/01/2020 | Serial | 001 |
| Patient Name | Mrs. LAXMI JAT | Contact No | 8337082611 |
| Address | DEY STREET, PAL BAGAN | Age | 16 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||