Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 04265 | Date 16/03/2019 |
| Token No | SM/18-19/10688 16/03/2019 | Serial | 070 Last Visit: 16/03/2019 |
| Patient Name | Miss RUPSA KHATUN | Contact No | 7890681705 |
| Address | CHATRA MUSALMAN PARA | Age | 7 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 19 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||