Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03043 | Date 17/01/2019 |
| Token No | SM/18-19/6952 17/01/2019 | Serial | 032 Last Visit: 17/01/2019 |
| Patient Name | Mrs. KORAISHIN HOSNA | Contact No | 9874158416 |
| Address | CHATRA BOU BAJAR | Age | 6 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 17 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||