Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02065 | Date 20/11/2018 |
| Token No | SM/18-19/3994 20/11/2018 | Serial | 072 Last Visit: 20/11/2018 |
| Patient Name | Miss SAIRA KHATUN | Contact No | 8584049603 |
| Address | CHATRA MUSALMAN PARA | Age | 15 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 31 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||