Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 07200 | Date 11/10/2022 |
| Token No | SM/22-23/5601 17/10/2022 | Serial | 055 |
| Patient Name | Master GOURAB JOT | Contact No | 9123625015 |
| Address | 10 DEY STREET | Age | 10 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||