Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00488 | Date 20/08/2018 |
| Token No | SM/19-20/8509 28/01/2020 | Serial | 009 |
| Patient Name | Mrs. KUMARI DEVI RAM | Contact No | NOT GIVEN |
| Address | DOSTI LANE | Age | 50 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||