Ticket for Outdoor Patient
| Ward No. 9 | U-PHC No. | Registration No. 14110 | Date 27/02/2026 |
| Token No | SM/25-26/3725 02/03/2026 | Serial | 002 |
| Patient Name | Miss DIPALI DAS | Contact No | 8777782954 |
| Address | 20 BAZAR BYE LANE | Age | 20 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||