Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 05770 | Date 28/04/2022 |
| Token No | SM/22-23/15014 29/02/2024 | Serial | 011 |
| Patient Name | Mrs. SARITA DEBI | Contact No | |
| Address | Age | 19 YRS Female | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||