Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 04063 | Date 12/10/2020 |
| Token No | SM/25-26/3065 22/12/2025 | Serial | 003 |
| Patient Name | Mrs. RAMA GHOSH | Contact No | 9007635361 |
| Address | BHAGIRATHI LANE | Age | 43 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||