Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 13573 | Date 08/10/2025 |
| Token No | SM/25-26/2227 09/10/2025 | Serial | 028 |
| Patient Name | Miss CHAITALI KONAI | Contact No | 9681865115 |
| Address | 56 DHULIPARA LANE | Age | 17 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||