Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 08368 | Date 17/02/2023 |
| Token No | SM/25-26/3016 17/12/2025 | Serial | 004 |
| Patient Name | Mr. BIJAY SAMAL | Contact No | 8777524250 |
| Address | 21 CHOWDHURY PARA LANE | Age | 57 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||