Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03181 | Date 25/01/2019 |
| Token No | SM/18-19/7436 25/01/2019 | Serial | 026 Last Visit: 25/01/2019 |
| Patient Name | Mrs. GULSANA KHATUN | Contact No | 8820217073 |
| Address | 7/D ARBINDA SARANI CHATRA | Age | 17 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 61 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||