Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02130 | Date 26/11/2018 |
| Token No | SM/18-19/4171 26/11/2018 | Serial | 044 Last Visit: 26/11/2018 |
| Patient Name | Mrs. SAHANARA KHATUN | Contact No | 7044171059 |
| Address | SHEORAFULI CHATRA MUSALMAN PARA | Age | 19 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 45 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||