Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03733 | Date 13/01/2020 |
| Token No | SM/19-20/8400 16/01/2020 | Serial | 003 |
| Patient Name | Mrs. NIRUPAMA NAYAK | Contact No | 9748664898 |
| Address | N L BHATTACHARYA STREET | Age | 27 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||