Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02605 | Date 20/12/2018 |
| Token No | SM/18-19/5513 20/12/2018 | Serial | 026 Last Visit: 10/09/2020 |
| Patient Name | Miss CHANDANI KHATUN | Contact No | |
| Address | 21 MUSALMAN PARA BYE LANE AIMACHAPSARA SHEORAPHULI | Age | 5 YRS Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 18 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||