Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 13760 | Date 21/11/2025 |
| Token No | SM/25-26/2706 22/11/2025 | Serial | 004 |
| Patient Name | Mrs. SHIMA DEY SARKAR | Contact No | 9163072085 |
| Address | 103 J.N. LAHIRI ROAD | Age | 52 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||