Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 02063 | Date 20/11/2018 |
| Token No | SM/18-19/3992 20/11/2018 | Serial | 070 Last Visit: 19/08/2019 |
| Patient Name | Miss HASINA KHATUN | Contact No | 7044688945 |
| Address | CHATRA MUSALMAN PARA | Age | 7 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 20 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||