Ticket for Outdoor Patient
| Ward No. 18 | U-PHC No. | Registration No. 13165 | Date 25/06/2025 |
| Token No | SM/25-26/1011 26/06/2025 | Serial | 031 |
| Patient Name | Mrs. SHANTA CHAKRABORTY | Contact No | 8902316007 |
| Address | 121 N N COLONY | Age | 59 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||