Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 13897 | Date 29/12/2025 |
| Token No | SM/25-26/3104 29/12/2025 | Serial | 010 |
| Patient Name | Mrs. TAPATI BHOWMICK | Contact No | 8777024969 |
| Address | 62 DHULIPARA LANE | Age | 62YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||