Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01691 | Date 26/10/2018 |
| Token No | SM/18-19/6800 14/01/2019 | Serial | 091 Last Visit: 15/05/2019 |
| Patient Name | Baby SURIYA KHATUN | Contact No | 8240213055 |
| Address | CHATRA MUSALMAN PARA | Age | 8 MANTH Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||