Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 13791 | Date 27/11/2025 |
| Token No | SM/25-26/2814 29/11/2025 | Serial | 003 |
| Patient Name | Mr. AJIT KUMAR DEY | Contact No | 9331906953 |
| Address | 22/I FIRINGI DANGA ROAD, MALLICKPARA | Age | 75 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||