Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05427 | Date 14/02/2022 |
| Token No | SM/25-26/1004 26/06/2025 | Serial | 024 |
| Patient Name | Mr. GOUTAM KUMAR BALI | Contact No | 7679299513 |
| Address | 38A DEY STREET | Age | 62 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||