Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00750 | Date 20/09/2018 |
| Token No | SM/25-26/3033 18/12/2025 | Serial | 003 |
| Patient Name | Mr. MADHUSUDAN PRADHAN | Contact No | 9681660305 |
| Address | 9 INDIA JUTE MILL | Age | 64 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||