Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 13784 | Date 26/11/2025 |
| Token No | SM/25-26/2792 27/11/2025 | Serial | 008 |
| Patient Name | Mr. SURJAYA GUCHAIT | Contact No | 7980707495 |
| Address | MAHESH | Age | 11 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||