Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01759 | Date 29/10/2018 |
| Token No | SM/18-19/3116 29/10/2018 | Serial | 088 Last Visit: 29/10/2018 |
| Patient Name | Miss MANTASA KHATUN | Contact No | 8697619357 |
| Address | 13, CHATRA MUSALMAN PARA | Age | 7 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 16 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||