Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13174 | Date 26/06/2025 |
| Token No | SM/25-26/1040 30/06/2025 | Serial | 025 |
| Patient Name | Mrs. DAMAYANTI BISWAL | Contact No | 6291855748 |
| Address | 7/282 COKREN ROAD | Age | 46 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||