Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04736 | Date 16/08/2021 |
| Token No | SM/25-26/1209 14/07/2025 | Serial | 013 |
| Patient Name | Mrs. DAMAYANTI SHYAMAL | Contact No | 9748011060 |
| Address | 9 NO LINE, INDIA JUTE MILL | Age | 57 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||