Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01669 | Date 14/02/2019 |
| Token No | SM/19-20/8170 30/12/2019 | Serial | 009 |
| Patient Name | Mrs. CHANDRAMA PARIDA | Contact No | NOT GIVEN |
| Address | 9 NO LINE JUTE MILL | Age | 60 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||