Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01916 | Date 05/11/2018 |
| Token No | SM/18-19/4123 24/11/2018 | Serial | 053 Last Visit: 24/11/2018 |
| Patient Name | Baby SHAYEBA KHATUN | Contact No | |
| Address | SHEORAPHULY,CHATRA MUSALMAN PARA | Age | 1 Y 5 M Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 12 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||