Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 03639 | Date 19/12/2019 |
| Token No | SM/19-20/8135 19/12/2019 | Serial | 003 |
| Patient Name | Mrs. DURGI HARI | Contact No | NOT GIVEN |
| Address | LAXMIGHAT | Age | 42 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||