Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 10063 | Date 21/08/2023 |
| Token No | SM/22-23/11810 21/08/2023 | Serial | 045 |
| Patient Name | Mrs. MOLLIKA SOM | Contact No | |
| Address | Age | 49 YRS Female | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||