Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 02655 | Date 22/12/2018 |
| Token No | SM/18-19/5662 22/12/2018 | Serial | 039 Last Visit: 22/12/2018 |
| Patient Name | Mrs. MAIRUN NISA | Contact No | |
| Address | 5, PARSI LANE SILBAGAN | Age | 35 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 53.5 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||