Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03964 | Date 02/03/2019 |
| Token No | SM/18-19/9752 02/03/2019 | Serial | 071 Last Visit: 22/07/2019 |
| Patient Name | Miss ASHMA KHATUN | Contact No | 7059904137 |
| Address | CHATRA MUSALMAN PAAR | Age | 15 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||