Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03834 | Date 19/02/2020 |
| Token No | SM/19-20/8590 19/02/2020 | Serial | 002 |
| Patient Name | Mr. BALARAM DAS | Contact No | |
| Address | Age | 37 Y Male | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||