Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 14108 | Date 26/02/2026 |
| Token No | SM/25-26/3724 02/03/2026 | Serial | 001 |
| Patient Name | Mrs. HARA APAT | Contact No | 8981649638 |
| Address | 30 DR. N L B STREET | Age | 55 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||