Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 11184 | Date 21/02/2024 |
| Token No | SM/25-26/1605 09/08/2025 | Serial | 001 |
| Patient Name | Mrs. GOURI DOM | Contact No | 7449792838 |
| Address | SHAMSHAN KALI | Age | 43 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||