Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01747 | Date 29/10/2018 |
| Token No | SM/18-19/3087 29/10/2018 | Serial | 059 Last Visit: 10/12/2019 |
| Patient Name | Baby AFIYA KHATUN | Contact No | 9831236433 |
| Address | 1, CHATRA MUSALMAN PARA | Age | 2 y 1 m Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||