Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 02622 | Date 26/07/2019 |
| Token No | SM/18-19/5150 26/07/2019 | Serial | 029 |
| Patient Name | Mrs. MAMTA DEVI | Contact No | 7890060545 |
| Address | 104 R B SARANI | Age | 28 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||