Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 05056 | Date 16/11/2021 |
| Token No | SM/21-22/1415 16/11/2021 | Serial | 020 |
| Patient Name | Mr. GOUTAM DAS | Contact No | |
| Address | Age | 50 Male | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||