Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01415 | Date 29/09/2018 |
| Token No | SM/18-19/2229 29/09/2018 | Serial | 017 Last Visit: 29/09/2018 |
| Patient Name | Miss SUHANA KHATUN | Contact No | 7686829852 |
| Address | CHATRA MUSALMAN PARA | Age | 12 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 29 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||