Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 13564 | Date 23/09/2025 |
| Token No | SM/25-26/2178 27/09/2025 | Serial | 001 |
| Patient Name | Mr. MD SAHEED | Contact No | 9903266788 |
| Address | 8 RAJMOHAN GOSWAMI LANE | Age | 34 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||