Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02604 | Date 20/12/2018 |
| Token No | SM/18-19/5512 20/12/2018 | Serial | 025 Last Visit: 20/12/2018 |
| Patient Name | Mrs. SUIFIYA BEGAM | Contact No | |
| Address | 49, CHATRA MUSALMAN PARA | Age | 35 YRS Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 63 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||