Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02793 | Date 13/08/2019 |
| Token No | SM/18-19/5671 16/08/2019 | Serial | 039 |
| Patient Name | Mrs. MAMTA DEBI | Contact No | 9903127113 |
| Address | RAM SITA LANE | Age | 35 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||