Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03377 | Date 12/12/2022 |
| Token No | SM/25-26/2512 24/05/2025 | Serial | 003 |
| Patient Name | Mrs. JYOTSNA DAS | Contact No | 6290980507 |
| Address | 15/32/B/N GODAR BAGAN BYE LANE CHATRA BAIDYABATI M 712204 | Age | 79 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | 130/70 mmHg | Weight | 65 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||