Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 04733 | Date 17/04/2019 |
| Token No | SM/19-20/1026 17/04/2019 | Serial | 033 Last Visit: 17/04/2019 |
| Patient Name | Mrs. MOURSA BIBI | Contact No | |
| Address | 33/A CHATRA MUSALMAN PARA | Age | 45 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 61 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||