Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04554 | Date 30/06/2021 |
| Token No | SM/21-22/1482 24/11/2021 | Serial | 031 |
| Patient Name | Mrs. MAMATA PRADHAN | Contact No | NOT GIVEN |
| Address | ram sita lane | Age | 26 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||