Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02636 | Date 21/12/2018 |
| Token No | SM/18-19/5590 21/12/2018 | Serial | 040 Last Visit: 21/12/2018 |
| Patient Name | Baby MAHERA KHATUN | Contact No | 9088030702 |
| Address | CHATRA MUSALMAN PARA | Age | 1 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||