Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04052 | Date 24/09/2020 |
| Token No | SM/20-21/9186 23/03/2021 | Serial | 001 |
| Patient Name | Mrs. PUJA DEVI | Contact No | 8622066875 |
| Address | 11 NO LINE | Age | 22 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||