Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01210 | Date 19/09/2018 |
| Token No | SM/18-19/1802 19/09/2018 | Serial | 014 Last Visit: 19/09/2018 |
| Patient Name | Mr. SK AJRUDIN | Contact No | 7450965951 |
| Address | CHATRA MUSALMAN PARA BYE LANE | Age | 15 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 45 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||