Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00703 | Date 13/09/2018 |
| Token No | SM/21-22/235 06/05/2021 | Serial | 013 |
| Patient Name | Miss PRIYA DAS | Contact No | NOT GIVEN |
| Address | CHATRA | Age | 18 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||