Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 05160 | Date 15/12/2021 |
| Token No | SM/21-22/1680 20/12/2021 | Serial | 014 |
| Patient Name | Miss NABAMITA BHAR | Contact No | 8240610582 |
| Address | 375/1 RAMKRISHNA ROAD, CHATRA | Age | 22 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||