Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01294 | Date 22/11/2018 |
| Token No | SM/18-19/6727 27/09/2019 | Serial | 001 |
| Patient Name | Mr. JAY PRAKASH RAY | Contact No | 8013280906 |
| Address | 180 QUATER, RAM SITA LANE | Age | 47 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||