Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 04669 | Date 28/07/2021 |
| Token No | SM/25-26/6077 27/10/2026 | Serial | 006 |
| Patient Name | Mrs. SHAMPA PAKIRA | Contact No | 8442811059 |
| Address | 13 AB GARDEN LANE | Age | 40 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||