Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 14496 | Date 04/06/2026 |
| Token No | SM/25-26/6088 28/10/2026 | Serial | 008 |
| Patient Name | Mr. MOHANCHANDRA DAS | Contact No | 8820327271 |
| Address | PATUAPARA | Age | 65 Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||