Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 03147 | Date 22/01/2019 |
| Token No | SM/18-19/7299 22/01/2019 | Serial | 070 Last Visit: 07/05/2019 |
| Patient Name | Miss NAFISA PARVHIN | Contact No | 8336059964 |
| Address | 5 PASHILANE ,SHILBAGAN | Age | 9 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 20 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||