Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 05728 | Date 20/04/2022 |
| Token No | SM/22-23/2764 20/04/2022 | Serial | 018 |
| Patient Name | Mrs. DIVYABHARATI SAHU | Contact No | |
| Address | Age | 31 Female | |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||