Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00139 | Date 08/08/2018 |
| Token No | SM/18-19/3137 08/04/2019 | Serial | 018 |
| Patient Name | Mrs. ASHA DEBI | Contact No | 8013280906 |
| Address | RAM SITA LANE | Age | 34 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||