Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01690 | Date 26/10/2018 |
| Token No | SM/18-19/2938 26/10/2018 | Serial | 052 Last Visit: 22/02/2019 |
| Patient Name | Miss MASRUFA KHATUN | Contact No | |
| Address | 7/B CHATRA MUSALMAN PARA | Age | 10 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 20 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||