Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03711 | Date 07/01/2020 |
| Token No | SM/19-20/8409 16/01/2020 | Serial | 012 |
| Patient Name | Mrs. TULU BESRA | Contact No | 7602470178 |
| Address | BSNL OFFICE EMPLOYEE | Age | 42 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||