Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04403 | Date 19/05/2021 |
| Token No | SM/21-22/285 19/05/2021 | Serial | 007 |
| Patient Name | Miss SHILPA PARUI | Contact No | 8013270238 |
| Address | NALIKUL | Age | 21 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||