Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 03494 | Date 12/02/2019 |
| Token No | SM/18-19/8416 12/02/2019 | Serial | 020 Last Visit: 12/02/2019 |
| Patient Name | Miss NAFISA SULTANA | Contact No | 9007756219 |
| Address | CHATRA BOU BAJAR BAIDYABATI(M) | Age | 6 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 16 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||