Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 13753 | Date 20/11/2025 |
| Token No | SM/25-26/2721 24/11/2025 | Serial | 008 |
| Patient Name | Mrs. DOLLY ROY | Contact No | 8697613975 |
| Address | 55 ROYLAND ROAD | Age | 42 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||