Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 13780 | Date 26/11/2025 |
| Token No | SM/25-26/2786 27/11/2025 | Serial | 002 |
| Patient Name | Mrs. SUKESHINI SOREN | Contact No | 8585812749 |
| Address | LALIT ABASAN, DEY STREET | Age | 80 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||