Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 02701 | Date 27/12/2018 |
| Token No | SM/18-19/5815 27/12/2018 | Serial | 073 Last Visit: 27/12/2018 |
| Patient Name | Miss AFSANA KHATUN | Contact No | 8100149716 |
| Address | 5 PARSHI LANE | Age | 8 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 17 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||