Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 02997 | Date 14/01/2019 |
| Token No | SM/18-19/6784 14/01/2019 | Serial | 075 Last Visit: 14/01/2019 |
| Patient Name | Baby PARMIN KHATUN | Contact No | 6290409582 |
| Address | 23A DARJI LANE, MALLIK PARA | Age | 5 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 12 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||