Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04847 | Date 01/09/2021 |
| Token No | SM/25-26/2333 18/10/2025 | Serial | 006 |
| Patient Name | Mrs. UMA ADAK | Contact No | 8420157944 |
| Address | DHULIPARA | Age | 65 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||