Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02999 | Date 06/09/2019 |
| Token No | SM/18-19/6256 06/09/2019 | Serial | 004 |
| Patient Name | Mrs. DANAYANTI SAMAL | Contact No | |
| Address | Age | 50 Female | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||