Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03100 | Date 23/09/2019 |
| Token No | SM/18-19/6733 27/09/2019 | Serial | 007 |
| Patient Name | Mrs. MOTI SHA | Contact No | NOT GIVEN |
| Address | 3 NO RAM SITA LANE | Age | 61 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||