Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04193 | Date 24/03/2021 |
| Token No | SM/20-21/9200 24/03/2021 | Serial | 003 |
| Patient Name | Mrs. MAMATA BISWAL | Contact No | NOT GIVEN |
| Address | 7 NO LINE, RAM SITA LANE | Age | 36 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||