Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 07203 | Date 11/10/2022 |
| Token No | SM/22-23/6364 15/11/2022 | Serial | 051 |
| Patient Name | Mrs. DIPA DEVI | Contact No | 9123003026 |
| Address | 6 NAYA BAGAN | Age | 20 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||