Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 13152 | Date 25/06/2025 |
| Token No | SM/25-26/1008 26/06/2025 | Serial | 028 |
| Patient Name | Mrs. PRIYANKA KOIRI | Contact No | 7980070955 |
| Address | 79 dey street | Age | 25 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||