Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 13804 | Date 01/12/2025 |
| Token No | SM/25-26/2940 10/12/2025 | Serial | 002 |
| Patient Name | Mrs. RITA DEY | Contact No | 9331906953 |
| Address | 22/1 FIRINGI DANGA ROAD | Age | 73 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||