Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03738 | Date 14/01/2020 |
| Token No | SM/19-20/8404 16/01/2020 | Serial | 007 |
| Patient Name | Mrs. CHANDRAMA SAPATI | Contact No | NOT GIVEN |
| Address | KHOLA BARI | Age | 61 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||