Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 07484 | Date 02/11/2022 |
| Token No | SM/22-23/5970 02/11/2022 | Serial | 011 |
| Patient Name | Miss SAMPLI PAL | Contact No | |
| Address | Age | 14 Female | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||