Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 00591 | Date 20/08/2018 |
| Token No | SM/18-19/698 20/08/2018 | Serial | 042 Last Visit: 11/03/2019 |
| Patient Name | Mrs. KHADIJA KHATUN | Contact No | 9007755751 |
| Address | 4/A CHATRA ARBINDO SARNI | Age | 14.0 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 37.5 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||