Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 10733 | Date 06/11/2023 |
| Token No | SM/25-26/1208 14/07/2025 | Serial | 012 |
| Patient Name | Mr. SAILEN DAS | Contact No | 8777803912 |
| Address | 26 DHULIPARA LANE | Age | 68 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||