Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05125 | Date 29/11/2021 |
| Token No | SM/21-22/1540 29/11/2021 | Serial | 015 |
| Patient Name | Mrs. SWARNAREKHA PATRA | Contact No | NOT GIVEN |
| Address | INDIA JUTE MILL | Age | 27 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||