Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 08931 | Date 04/11/2020 |
| Token No | SM/20-21/27136 04/11/2020 | Serial | 033 Last Visit: 04/11/2020 |
| Patient Name | Mrs. CHAMPA SHAW | Contact No | |
| Address | SHEORAPHULI | Age | 43 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||