Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 04226 | Date 31/03/2021 |
| Token No | SM/21-22/1638 14/12/2021 | Serial | 029 |
| Patient Name | Mr. DHIREN BARIK. | Contact No | NOT GIVEN |
| Address | CHATRA BARUI PARA LANE | Age | 43 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||