Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02961 | Date 01/09/2019 |
| Token No | SM/18-19/6189 03/09/2019 | Serial | 036 |
| Patient Name | Mr. GANESH SWAIN | Contact No | 9681962237 |
| Address | 14B DEY STREET | Age | 42 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||