Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 12170 | Date 30/09/2024 |
| Token No | SM/25-26/2942 10/12/2025 | Serial | 004 |
| Patient Name | Mr. SHIBSHANKAR DEY | Contact No | 7890955253 |
| Address | DEY STREET | Age | 30 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||