Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05457 | Date 21/02/2022 |
| Token No | SM/21-22/2241 22/02/2022 | Serial | 013 |
| Patient Name | Mrs. SUSHILA PARIADA | Contact No | NOT GIVEN |
| Address | RAM SITA LINE | Age | 50 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||