Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 04050 | Date 06/03/2019 |
| Token No | SM/18-19/9995 06/03/2019 | Serial | 085 Last Visit: 06/03/2019 |
| Patient Name | Miss ROJINA KHATUN | Contact No | 8697436683 |
| Address | 20 CHATRA KUMOR PARA | Age | 14 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 36 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||