Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 04263 | Date 16/03/2019 |
| Token No | SM/18-19/10686 16/03/2019 | Serial | 068 Last Visit: 16/03/2019 |
| Patient Name | Miss ASPIYA KHATUN | Contact No | 7890681705 |
| Address | CHATRA MUSALMAN PARA | Age | 12 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 35 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||