Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00097 | Date 06/08/2018 |
| Token No | SM/18-19/4063 10/06/2019 | Serial | 031 |
| Patient Name | Mrs. KUNTALA BISWAL | Contact No | 9836010315 |
| Address | 9,INDIAN JUTE MILL | Age | 60 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||