Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 13682 | Date 31/10/2025 |
| Token No | SM/25-26/2498 03/11/2025 | Serial | 034 |
| Patient Name | Mrs. JILEBI DEBI | Contact No | 8092973280 |
| Address | 43 BHAGIRATHI LANE | Age | 70 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||