Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04170 | Date 18/03/2021 |
| Token No | SM/20-21/9172 18/03/2021 | Serial | 004 |
| Patient Name | Mr. AGNI DAS | Contact No | |
| Address | Age | 11 YRS Male | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||