Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 12899 | Date 21/04/2025 |
| Token No | SM/25-26/183 21/04/2025 | Serial | 028 |
| Patient Name | Mrs. SAMPA RANI PATTANAYAK | Contact No | 9330105504 |
| Address | 101 GT ROAD | Age | 25 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||