Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02040 | Date 10/05/2019 |
| Token No | SM/25-26/2874 04/12/2025 | Serial | 009 |
| Patient Name | Mr. GANESH BARIK | Contact No | 8282932054 |
| Address | 45 DR. N L B STREET | Age | 75 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||