Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01587 | Date 17/01/2019 |
| Token No | SM/18-19/2846 13/03/2019 | Serial | 036 |
| Patient Name | Mrs. DAMAYANTI SAMON | Contact No | NOT GIVEN |
| Address | 9 NO LINE | Age | 50 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||