Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02742 | Date 29/12/2018 |
| Token No | SM/18-19/8201 07/02/2019 | Serial | 028 Last Visit: 07/02/2019 |
| Patient Name | Miss RESHMA KHATUN | Contact No | 7890759202 |
| Address | 30A CHATRA MUSALMAN PARA | Age | 13 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 50 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||