Ticket for Outdoor Patient
| Ward No. 21 | U-PHC No. | Registration No. 12171 | Date 30/09/2024 |
| Token No | SM/24-25/19116 30/09/2024 | Serial | 040 |
| Patient Name | Mrs. RUMPA DAS | Contact No | 8820557222 |
| Address | 1/A/2 B.P.2ND LANE | Age | Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||