Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 13396 | Date 18/08/2025 |
| Token No | SM/25-26/1704 18/08/2025 | Serial | 004 |
| Patient Name | Mrs. NIVA SHAW | Contact No | 858482800 |
| Address | 6 NO RAMSITA LANE | Age | 25 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||