Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04813 | Date 26/08/2021 |
| Token No | SM/25-26/1989 10/09/2025 | Serial | 016 |
| Patient Name | Mrs. CHAYNA ADAK | Contact No | 9748609480 |
| Address | DHULIPARA LANE | Age | 59 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||