Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 05009 | Date 27/10/2021 |
| Token No | SM/21-22/1322 27/10/2021 | Serial | 024 |
| Patient Name | Mr. GOUR BHAR | Contact No | |
| Address | Age | 57 Male | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||