Ticket for Outdoor Patient
| Ward No. 6 | U-PHC No. | Registration No. 03568 | Date 13/02/2019 |
| Token No | SM/18-19/8635 13/02/2019 | Serial | 102 Last Visit: 13/02/2019 |
| Patient Name | Miss KOYAL KHATUN | Contact No | |
| Address | SEORAPHULI, | Age | 6 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 25 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||