Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03171 | Date 10/10/2019 |
| Token No | SM/18-19/6883 11/10/2019 | Serial | 009 |
| Patient Name | Mrs. PROVA BISWAL | Contact No | NOT GIVEN |
| Address | MAHESH COLONY | Age | 40 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||