Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 02138 | Date 26/11/2018 |
| Token No | SM/18-19/4188 26/11/2018 | Serial | 061 Last Visit: 26/11/2018 |
| Patient Name | Miss TUHINA KHATUN | Contact No | 9051867258 |
| Address | 83 MALLICK PARA | Age | 6 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 15 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||