Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04203 | Date 30/03/2021 |
| Token No | SM/20-21/9214 30/03/2021 | Serial | 002 |
| Patient Name | Mrs. BASANTI PARIDA | Contact No | 8712374793 |
| Address | 8/413 INDIA JUTE MILL | Age | 43 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||