Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 02261 | Date 01/12/2018 |
| Token No | SM/18-19/4554 03/12/2018 | Serial | 020 Last Visit: 03/12/2018 |
| Patient Name | Miss PEALI POREL | Contact No | 9874057826 |
| Address | 32 BHADURI PARA LANE | Age | 19 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||