Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 00775 | Date 28/08/2018 |
| Token No | SM/19-20/5015 21/06/2019 | Serial | 041 Last Visit: 15/12/2025 |
| Patient Name | Mrs. DIPALI ASH | Contact No | 9836038633 |
| Address | 79 BARUI PARA CHATRA | Age | 55 Years,11 Months,13 Days Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||