Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02115 | Date 24/11/2018 |
| Token No | SM/18-19/4122 24/11/2018 | Serial | 052 Last Visit: 24/11/2018 |
| Patient Name | Miss SULTANA KHATUN | Contact No | 8017365789 |
| Address | 41/A CHATRA MUSALMAN PARA | Age | 13 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 37 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||