Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01951 | Date 22/04/2019 |
| Token No | SM/25-26/2639 17/11/2025 | Serial | 003 |
| Patient Name | Mr. LAXMI NARAYAN SIL | Contact No | 8420715777 |
| Address | 18 DEY STREET | Age | 52 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||