Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04751 | Date 17/08/2021 |
| Token No | SM/21-22/871 17/08/2021 | Serial | 014 |
| Patient Name | Mrs. SHAMPA PAKIRA | Contact No | |
| Address | Age | 35 Female | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||