Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00110 | Date 07/08/2018 |
| Token No | SM/25-26/2434 30/10/2025 | Serial | 003 |
| Patient Name | Mr. ARUN DEY | Contact No | 9681059717 |
| Address | 90C DEY STREET | Age | 75 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||