Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 04991 | Date 26/10/2021 |
| Token No | SM/21-22/2116 09/02/2022 | Serial | 005 |
| Patient Name | Mrs. LALITA BARIK | Contact No | 7278830385 |
| Address | 5 AKHRABATI LANE | Age | 48 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||