Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04458 | Date 08/06/2021 |
| Token No | SM/25-26/2551 10/11/2025 | Serial | 003 |
| Patient Name | Mrs. GUDDI DEBI | Contact No | 7278220735 |
| Address | 8 NO LINE | Age | 36 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||