Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01682 | Date 26/10/2018 |
| Token No | SM/18-19/3683 14/11/2018 | Serial | 072 Last Visit: 01/10/2019 |
| Patient Name | Miss SUHANA KHATUN | Contact No | |
| Address | 29 CHATRA MUSALMAN PARA,SHEORAPHULI | Age | 10 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 25 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||