Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01147 | Date 14/09/2018 |
| Token No | SM/18-19/10834 19/03/2019 | Serial | 027 Last Visit: 19/03/2019 |
| Patient Name | Mrs. AJMIRA KHATUN | Contact No | 9331441867 |
| Address | 9 CHATRA ARBINDA SARANI | Age | 12 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 27 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||