Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01821 | Date 27/03/2019 |
| Token No | SM/18-19/2918 27/03/2019 | Serial | 004 |
| Patient Name | Mrs. REBA PAUL | Contact No | 8420358923 |
| Address | 54 A.B. GARDEN LANE | Age | 56 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||