Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03082 | Date 19/01/2019 |
| Token No | SM/18-19/7213 21/01/2019 | Serial | 081 Last Visit: 21/01/2019 |
| Patient Name | Mrs. AJMIRA BIBI | Contact No | |
| Address | 15 SHEWRAPHULI MALLIK PARA | Age | 60 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 58 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||