Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01846 | Date 30/03/2019 |
| Token No | SM/18-19/2984 30/03/2019 | Serial | 002 |
| Patient Name | Mrs. SARDA KOIRI | Contact No | NOT GIVEN |
| Address | 79 DEY ST | Age | 40 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||