Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02319 | Date 20/06/2019 |
| Token No | SM/18-19/4407 24/06/2019 | Serial | 037 |
| Patient Name | Mrs. LAXMI SWAIN | Contact No | 9906779941 |
| Address | 12 PITAMBAR DEY LANE | Age | 41 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||