Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 14574 | Date 08/07/2026 |
| Token No | SM/25-26/6087 28/10/2026 | Serial | 007 |
| Patient Name | Mrs. SIBANI PARIDA | Contact No | 9088184790 |
| Address | 469/9 COCKRAIN ROAD | Age | 23 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||