Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 09975 | Date 18/09/2025 |
| Token No | SM/25-26/8189 19/09/2025 | Serial | 010 |
| Patient Name | Mrs. MOMENA BIBI | Contact No | 7003832979 |
| Address | 28/F CHILEKHANA ROAD SERAMPORE 712203 | Age | 35 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||