Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01426 | Date 29/09/2018 |
| Token No | SM/18-19/2258 29/09/2018 | Serial | 046 Last Visit: 05/12/2018 |
| Patient Name | Baby SUJANA KHATUN | Contact No | |
| Address | 5/C CHATRA MUSALMAN PARA | Age | 6 MONTH Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||