Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02814 | Date 04/01/2019 |
| Token No | SM/18-19/6237 04/01/2019 | Serial | 022 Last Visit: 04/01/2019 |
| Patient Name | Baby TABSUM KHATUN | Contact No | |
| Address | 7, ARBINDO SARANI CHATRA | Age | 4.7 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||