Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 04074 | Date 07/03/2019 |
| Token No | SM/18-19/10105 07/03/2019 | Serial | 108 Last Visit: 01/04/2019 |
| Patient Name | Baby MUSARAT JAHAN | Contact No | 9831885141 |
| Address | 7 CHATRA KUMAR PARA | Age | 5 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 15 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||