Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01926 | Date 16/04/2019 |
| Token No | SM/18-19/6336 11/09/2019 | Serial | 006 |
| Patient Name | Mrs. BABY SHAW | Contact No | 6289048470 |
| Address | 10 RAM SITA LANE | Age | 46 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||