Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 02930 | Date 09/01/2019 |
| Token No | SM/18-19/6567 09/01/2019 | Serial | 056 Last Visit: 15/01/2019 |
| Patient Name | Miss AYESHA KHATUN | Contact No | 9748153381 |
| Address | 16 K M SHA STREET | Age | 6 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 17 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||