Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03726 | Date 10/01/2020 |
| Token No | SM/19-20/8346 13/01/2020 | Serial | 002 |
| Patient Name | Mrs. ISHRAWATI DEBI | Contact No | NOT GIVEN |
| Address | RAM SITA LANE | Age | 51 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||