Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 05396 | Date 08/02/2022 |
| Token No | SM/21-22/2156 16/02/2022 | Serial | 001 |
| Patient Name | Mrs. SANGITA KOIRI | Contact No | 8159921019 |
| Address | 79 DEY STREET | Age | 23 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||