Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01704 | Date 21/02/2019 |
| Token No | SM/18-19/5265 30/07/2019 | Serial | 030 |
| Patient Name | Mrs. KALAWATI DEVI | Contact No | 7980936744 |
| Address | RAM SITA LANE | Age | 67 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||