Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13309 | Date 28/07/2025 |
| Token No | SM/25-26/1446 29/07/2025 | Serial | 002 |
| Patient Name | Mrs. MADHURI DEBI | Contact No | 9163217047 |
| Address | 18 NO LINE DHARMATALA | Age | 50 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||