Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00680 | Date 13/09/2018 |
| Token No | SM/18-19/4245 17/06/2019 | Serial | 014 |
| Patient Name | Mr. SADANANDA BISWAL | Contact No | NOT GIVEN |
| Address | 41, INDIA JUTE MILL | Age | 75 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||