Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02644 | Date 21/12/2018 |
| Token No | SM/18-19/5620 21/12/2018 | Serial | 070 Last Visit: 03/06/2019 |
| Patient Name | Baby RIMPA KHATUN | Contact No | |
| Address | 18/1 CHATRA MUSALMAN PARA BY LANE | Age | 4 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 10 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||