Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04472 | Date 11/06/2021 |
| Token No | SM/25-26/3035 18/12/2025 | Serial | 005 |
| Patient Name | Mrs. KALPANA NANDY | Contact No | 6290811176 |
| Address | BANERJEE PARA | Age | 38 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||