Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 14990 | Date 28/10/2026 |
| Token No | SM/25-26/6089 28/10/2026 | Serial | 009 |
| Patient Name | Mrs. KAJAL TANTI | Contact No | 9865564244 |
| Address | 100 RB SARANI | Age | 22 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||