Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02522 | Date 14/12/2018 |
| Token No | SM/18-19/5218 14/12/2018 | Serial | 007 Last Visit: 14/12/2018 |
| Patient Name | Miss NURJAHAN KHATUN | Contact No | 8017558286 |
| Address | CHATRA MUSALMAN PARA | Age | 17 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 46 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||