Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 13690 | Date 03/11/2025 |
| Token No | SM/25-26/2556 10/11/2025 | Serial | 008 |
| Patient Name | Mrs. GOURI DE | Contact No | 9339961617 |
| Address | 613/B G.T. ROAD | Age | 68 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||