Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 05174 | Date 20/12/2021 |
| Token No | SM/21-22/1696 21/12/2021 | Serial | 011 |
| Patient Name | Mrs. MANJU PATRA | Contact No | NOT GIVEN |
| Address | 39/A BHAGIRATHI LANE | Age | 38 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||