Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 13410 | Date 26/08/2025 |
| Token No | SM/25-26/1780 28/08/2025 | Serial | 028 |
| Patient Name | Mr. ASOK DAS | Contact No | 7980780805 |
| Address | 6 BHAGIRATHI LANE | Age | 60 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||