Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03014 | Date 15/01/2019 |
| Token No | SM/18-19/6839 15/01/2019 | Serial | 032 Last Visit: 15/01/2019 |
| Patient Name | Miss ROBINA BEGUM | Contact No | |
| Address | 37 KUMOR PARA | Age | 18 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 50 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||