Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00648 | Date 04/09/2018 |
| Token No | SM/21-22/1110 09/09/2021 | Serial | 001 |
| Patient Name | Mr. RAM DULAR RAM | Contact No | |
| Address | Age | 72 Male | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||