Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01972 | Date 25/04/2019 |
| Token No | SM/18-19/4462 25/06/2019 | Serial | 050 |
| Patient Name | Mrs. PARBATI POLAI | Contact No | NOT GIVEN |
| Address | RAMSITA LANE | Age | 35 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||