Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01466 | Date 01/10/2018 |
| Token No | SM/18-19/7990 04/02/2019 | Serial | 086 Last Visit: 04/02/2019 |
| Patient Name | Miss SAHIN KAHTUN | Contact No | 8444979212 |
| Address | 7, CHATRA ARBINDA SARANI | Age | 13 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 35 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||