Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 09111 | Date 18/05/2023 |
| Token No | SM/22-23/9682 19/05/2023 | Serial | 004 |
| Patient Name | Mrs. SAMAPTIKA DAS | Contact No | 8777364290 |
| Address | 579 G.T. ROAD | Age | 45 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||