Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05178 | Date 21/12/2021 |
| Token No | SM/21-22/1717 22/12/2021 | Serial | 017 |
| Patient Name | Mrs. CHANDA DEVI | Contact No | 8873987678 |
| Address | 6/226 INDIA JUTE MILL | Age | 31 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||