Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02186 | Date 28/11/2018 |
| Token No | SM/18-19/4315 28/11/2018 | Serial | 047 Last Visit: 28/11/2018 |
| Patient Name | Mrs. KHAIRUN BIBI | Contact No | |
| Address | 21, CHATRA MUSALMAN PARA | Age | 65 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 44 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||