Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 01344 | Date 26/09/2018 |
| Token No | SM/18-19/2131 27/09/2018 | Serial | 012 Last Visit: 28/06/2019 |
| Patient Name | Mrs. LATIFA BIBI | Contact No | 8017058055 |
| Address | 86A MALLICK PARA | Age | 65 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||