Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02701 | Date 02/08/2019 |
| Token No | SM/18-19/5474 06/08/2019 | Serial | 053 |
| Patient Name | Mrs. G.SUNITA | Contact No | 8697488028 |
| Address | 137 NO INDIA JUTE MIL | Age | 27 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||