Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04875 | Date 06/09/2021 |
| Token No | SM/21-22/1066 06/09/2021 | Serial | 005 |
| Patient Name | Mrs. LAXMI DAS | Contact No | NOT GIVEN |
| Address | POTUA PARA | Age | 20 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||