Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 13167 | Date 26/06/2025 |
| Token No | SM/25-26/1014 28/06/2025 | Serial | 002 |
| Patient Name | Mrs. BINA DEY | Contact No | 7001898971 |
| Address | 627 G T ROAD | Age | 47 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||