Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 02356 | Date 05/12/2018 |
| Token No | SM/18-19/4728 05/12/2018 | Serial | 052 Last Visit: 05/12/2018 |
| Patient Name | Miss ARMINA KHATUN | Contact No | 9831507393 |
| Address | 83 MALLIK PARA SERAMPORE | Age | 16 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 52 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||