Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04102 | Date 08/03/2019 |
| Token No | SM/18-19/10205 08/03/2019 | Serial | 096 Last Visit: 08/03/2019 |
| Patient Name | Miss SONIYA KHATUN | Contact No | |
| Address | CHATRA MUSALMAN PARA | Age | 16 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||