Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03938 | Date 01/03/2019 |
| Token No | SM/18-19/9677 01/03/2019 | Serial | 052 Last Visit: 01/03/2019 |
| Patient Name | Miss SABIRA KHATUN | Contact No | 9331441867 |
| Address | 9 CHATRA ARBINDA SARANI | Age | 14 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 36 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||