Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05431 | Date 16/02/2022 |
| Token No | SM/21-22/2450 16/03/2022 | Serial | 015 |
| Patient Name | Mrs. SARITA DEVI | Contact No | 8910559779 |
| Address | 6 RAM SITA LANE | Age | 28 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||