Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 13305 | Date 28/07/2025 |
| Token No | SM/25-26/1503 31/07/2025 | Serial | 015 |
| Patient Name | Mrs. GITA DAS | Contact No | 8240004833 |
| Address | 14 J.N. LAHIRI ROAD | Age | 32 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||