Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03789 | Date 28/01/2020 |
| Token No | SM/19-20/8942 25/09/2020 | Serial | 004 |
| Patient Name | Mrs. GOURI DEY | Contact No | |
| Address | Age | 64 Female | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||